Chapter 3: Identification and Differentiated services

Impact of Disability and Vulnerability on daily life

Factors related to the person
People respond to disabilities in different ways. Some react negatively and thus their quality of
life is negatively affected. Others choose to focus on their abilities as opposed to their disabilities
and continue to live a productive life. There are several factors that affect the impact a disability
has on an individual. The following are often considered the most significant factors in
determining a disability's impact on an individual.
1. The Nature of the Disability: Disability can be acquired (a result of an accident, or
acquired disease) or congenital (present at birth). If the disability is acquired, it is more
likely to cause a negative reaction than a congenital disability. Congenital disabilities are
disabilities that have always been present, thus requiring less of an adjustment than an
acquired disability.
2. The Individual’s Personality - the individual personality can be typically positive or negative,
dependent or independent, goal-oriented or laissez-faire. Someone with a positive outlook is more
likely to embrace a disability then someone with a negative outlook. Someone who is independent
will continue to be independent and someone who is goal- oriented will continue to set and pursue
goals.
3. The Meaning of the Disability to the Individual - Does the individual define himself/herself by
his/her looks or physical characteristics? If so, he/she is more likely to feel defined by his/her
disability and thus it will have a negative impact.
4. The Individual’s Current Life Circumstances - The individual‘s independence or dependence
on others (parents). The economic status of the individual or the individual's caregivers, the
individual's education level. If the individual is happy with their current life circumstance, they are
more likely to embrace their disability, whereas if they are not happy with their circumstances, they
often blame their disability.
5. The Individual's Support System - The individual‘s support from family, a significant other,
friends, or social groups. If so, he/she will have an easier time coping with a disability and thus
will not be affected negatively by their disability.
Common effects of a disability may include but not limited to health conditions of the person;
mental health issues including anxiety and depression; loss of freedom and independence;
frustration and anger at having to rely on other people; practical problems including transport,
choice of activities, accessing buildings; unemployment; problems with learning and academic
study; loss of self-esteem and confidence, especially in social
situations. But all these negative effects are due to restricted environments, not due to
impairments.
The disability experience resulting from the interaction of health conditions, personal
factors, and environmental factors varies greatly. Persons with disabilities are diverse and
heterogeneous, while stereotypical views of disability emphasize wheelchair users and a few other
―classic‖ groups such as blind people and deaf people. Disability encompasses the child born with
a congenital condition such as cerebral palsy or the young soldier who loses his leg to a land-
mine, or the middle-aged woman with severe arthritis, or the older person with dementia, among
many others. Health conditions can be visible or invisible; temporary or long term; static,
episodic, or degenerating; painful or inconsequential. Note that many people with disabilities do
not consider themselves to be unhealthy. Generalizations about
―disability‖ or ―people with disabilities‖ can mislead. Persons with disabilities have diverse
personal factors with differences in gender, age, language, socioeconomic status, sexuality,
ethnicity, or cultural heritage. Each has his or her personal preferences and responses to disability.
Also while disability correlates with disadvantage, not all people with disabilities are equally
disadvantaged. Women with disabilities experience the combined disadvantages associated with
gender as well as disability, and may be less likely to marry than non- disabled women. People
who experience mental health conditions or intellectual impairments appear to be more
disadvantaged in many settings than those who experience physical or sensory impairments.
People with more severe impairments often experience greater disadvantage. Conversely, wealth
and status can help overcome activity limitations and participation restrictions.
People with disabilities and vulnerabilities live with challenges that impact their abilities
to conduct Activities of Daily Living (ADL). Disability and vulnerabilities can limit or restrict
one or more ADLs, including moving from one place to another (e.g., navigation, locomotion,
transfer), maintaining a position (e.g., standing, sitting, sleeping), interacting with the
environment (e.g., controlling systems, gripping objects), communicating (e.g.,
speaking, writing, hand gestures), feeding (chewing, swallowing, etc.), and perceiving the external
world (by movement of the eyes, the head, etc.), due to inaccessible environment. Many older
persons face one or more impairments. Their situation is often similar to that of people with
disabilities. Their needs are similar to those people with multiple disabilities with a decrease in the
muscular, vision, hearing and cognitive capacities.
Economic Factors and Disability
There is clear evidence that people with few economic assets are more likely to acquire
pathologies that may be disabling. This is true even in advanced economies and in economies with
greater levels of income equality. The impact of absolute or relative economic deprivation on the
onset of pathology crosscuts conditions with radically different etiologies, encompassing
infectious diseases and most common chronic conditions. Similarly, economic status affects
whether pathology will proceed to impairment. Examples include such phenomena as a complete
lack of access to or a delay in presentation for medical care for treatable conditions (e.g., untreated
breast cancer is more likely to require radical mastectomy) or inadequate access to state-of-the-art
care (e.g., persons with rheumatoid arthritis may experience a worsened range of motion and joint
function because disease- modifying drugs are not used by most primary care physicians). In turn,
a lack of resources can adversely affect the ability of an individual to function with a disabling
condition. For example, someone with an amputated leg who has little money or poor health
insurance may not be able to obtain a proper prosthesis, in which case the absence of the limb
may then force the individual to withdraw from jobs that require these capacities.
Similarly, economic resources can limit the options and abilities of someone who requires
personal assistance services or certain physical accommodations. The individual also may not be
able to access the appropriate rehabilitation services to reduce the degree of potential disability
either because they cannot afford the services themselves or cannot afford the cost of specialized
transportation services.
The economic status of the community may have a more profound impact than the status
of the individual on the probability that disability will result from impairment or other disabling
conditions. Research on employment among persons with disabilities indicates, for example, that
such persons in communities undergoing rapid economic expansion will be much more likely to
secure jobs than those in communities with depressed or contracting
labor markets. Similarly, wealthy communities are more able to provide environmental supports
such as accessible public transportation and public buildings or support payments for personal
assistance benefits.
Community can be defined in terms of the microsystem (the local area of the person with
the disabling conditions), the mesosystem (the area beyond the immediate neighborhood, perhaps
encompassing the town), and the macrosystem (a region or nation). Clearly, the economic status
of the region or nation as a whole may play a more important role than the immediate
microenvironment for certain kinds of disabling conditions. For example, access to employment
among people with disabling conditions is determined by a combination of the national and
regional labor markets, but the impact of differences across small neighborhoods is unlikely to be
very great. In contrast, the economic status of a neighborhood will play a larger role in
determining whether there are physical accommodations in the built environment that would
facilitate mobility for people with impairments or functional limitations, or both.
Finally, economic factors also can affect disability by creating incentives to define oneself
as disabled. For example, disability compensation programs often pay nearly as much as many of
the jobs available to people with disabling conditions, especially given that such programs also
provide health insurance and many lower-paying jobs do not. Moreover, disability compensation
programs often make an attempt to return to work risky, since health insurance is withdrawn soon
after earnings begin and procuring a job with good health insurance benefits is often difficult in
the presence of disabling conditions. Thus, disability compensation programs are said to
significantly reduce the number of people with impairments who work by creating incentives to
leave the labor force and also creating disincentives to return to work.
Political Factors and Disability
The political system, through its role in designing public policy, can and does have a profound
impact on the extent to which impairments and other potentially disabling conditions will result in
disability. If the political system is well enforced it will profoundly improve the prospects of
people with disabling conditions for achieving a much fuller participation in society, in effect
reducing the font of disability in work and every other
A. domain of human activity. The extent to which the built environment impedes people with disabling
conditions is a function of public funds spent to make buildings and transportation systems
accessible and Dysgraphia
public laws requiring the private sector to make these accommodations in nonpublic buildings.
The extent to which people with impairments and functional limitations will participate in the
labor force is a function of the funds spent in training programs, in the way that health care is
financed, and in the ways that job accommodations are mandated and paid for. Similarly, for those
with severe disabling conditions, access to personal assistance services may be required for
participation in almost all activities, and such access is dependent on the availability of funding for
such services through either direct payment or tax credits. Thus, the potential mechanisms of
public policy are diverse, ranging from the direct effects of funds from the public purse, to
creating tax incentives so that private parties may finance efforts themselves, to the passage of
civil rights legislation and providing adequate enforcement. The sum of the mechanisms used can
and does have a profound impact on the functioning of people with disabling conditions.
Factors Psychological of Disability
This section focuses on the impact of psychological factors on how disability and disabling
conditions are perceived and experienced. The argument in support of the influence of the
psychological environment is congruent with the key assumption in this chapter that the physical
and social environments are fundamentally important to the expression of disability.
Several constructs can be used to describe one's psychological environment, including personal
resources, personality traits, and cognition. These constructs affect both the expression of
disability and an individual's ability to adapt to and react to it. An exhaustive review of the
literature on the impact of psychological factors on disability is beyond the scope of this chapter.
However, for illustrative purposes four psychological constructs will be briefly discussed: three
cognitive processes (self-efficacy beliefs, psychological control, and coping patterns) and one
personality disposition (optimism). Each section provides examples illustrating the influence of
these constructs on the experience of disability.
a) Social Cognitive Processes
Cognition consists of thoughts, feelings, beliefs, and ways of viewing the world, others, and
ourselves. Three interrelated cognitive processes have been selected to illustrate the direct and
interactive effects of cognition on disability. These are self-efficacy beliefs, psychological
control, and coping patterns which all these are socially constructed.
b) Self-Efficacy Beliefs
Self-efficacy beliefs are concerned with whether or not a person believes that he or she can
accomplish a desired outcome (Bandura, 1977, 1986). Beliefs about one's abilities affect
what a person chooses to do, how much effort is put into a task, and how long an individual will
endure when there are difficulties. Self-efficacy beliefs also affect the person's affective and
emotional responses. Under conditions of high self-efficacy, a person's outlook and mental health
status will remain positive even under stressful and aversive situations. Under conditions of low
self-efficacy, mental health may suffer even when environmental conditions are favorable. The
findings from several studies provide evidence of improved behavioral and functional outcomes
under efficacious conditions for individuals with and without disabling conditions (Maddux,
1996). How do self-efficacy beliefs affect disability? Following a stroke, for example, an
individual with high self-efficacy beliefs will be more likely to feel and subsequently exert effort
toward reducing the disability that could accompany any stroke-related impairment or functional
limitation. The highly self- efficacious individual would work harder at tasks (i.e., in physical or
speech therapy), be less likely to give up when there is a relapse (i.e., continue therapy sessions
even when there is no immediate improvement), and in general, feel more confident and optimistic
about recovery and rehabilitation. These self-efficacy beliefs will thus mediate the relationship
between impairment and disability such that the individual would experience better functional
outcomes and less disability. The development of self-efficacy of the individual is much affected
by the environmental factors.
c) Psychological Control
Psychological control, or control beliefs, is akin to self-efficacy beliefs in that they are thoughts,
feelings, and beliefs regarding one's ability to exert control or change a situation. Self-generated
feelings of control improve outcomes for diverse groups of individuals with physical disabilities
and chronic illnesses. The onset of a disabling condition is often
followed by a loss or a potential loss of control. What is most critical for adaptive functioning is
how a person responds to this and what efforts the person puts forth to regain control. Perceptions
of control will influence whether disabling environmental conditions are seen as stressful and
consequently whether it becomes disabling. The individuals control over themselves depends on
the provision of the environments: accessibility or inaccessibility.
d) Coping Patterns
Coping patterns refer to behavioral and cognitive efforts to manage specific internal or external
demands that tax or exceed a person's resources to adjust. Generally, coping has been studied
within the context of stress. Having a disabling condition may create stress and demand additional
efforts because of interpersonal or environmental conditions that are not supportive. Several
coping strategies may be used when a person confronts a stressful situation. These strategies may
include the following: seeking information, cognitive restructuring, emotional expression,
catastrophizing, wish-fulfilling fantasizing, threat minimization, relaxation, distraction, and self-
blame. The effects of certain coping efforts on adaptive and functional outcomes benefits
individuals with disabling conditions. In general, among people with disabling conditions, there is
evidence that passive, avoidant, emotion- focused cognitive strategies (e.g., catastrophizing and
wishful thinking) are associated with poorer outcomes, whereas active, problem-focused attempts
to redefine thoughts to become more positive are associated with favorable outcomes. An adaptive
coping pattern would involve the use of primary and secondary control strategies. What seems
useful is the flexibility to change strategies and to have several strategies available.
Active coping is a significant predictor of mental health and employment-related outcomes.
Under conditions in which individuals with disabling conditions use active and problem-solving
coping strategies to manage their life circumstances, there will be better functional outcomes
across several dimensions (e.g., activities of daily living, and employment) than when passive
coping strategies are used. An important component in the coping process is appraisal. Appraisals
involve beliefs about one's ability to deal with a situation. Take, for example, two people with
identical levels of impairment. The appraisal that the impairment is disabling will result in more
disability than the appraisal that the impairment is not disabling, regardless of the objective type
and level of impairment.
Appraisal is related to self-efficacy in the sense that one's thoughts and cognition control
how one reacts to a potentially negative situation. When a person feels that he or she can execute a
desired outcome (e.g., learn how to use crutches for mobility), the person is more likely to do just
that. Similarly, under conditions in which an individual appraises his or her disabling conditions
and other life circumstances as manageable, the person will use coping strategies that will lead to
a manageable life (i.e., better functional outcomes).
e) Personality Disposition
Optimism is a personality disposition that is included in this chapter as an example of a
personality disposition or trait that can mediate how disabling conditions are experienced. Several
other interrelated personality factors could be discussed (e.g., self-esteem, hostility, and Type A
personality). Optimism (in contrast to pessimism) is used for illustrative purposes because it
relates to many other personality traits. Optimism is the general tendency to view the world,
others, and oneself favorably. People with an optimistic orientation rather than a pessimistic
orientation are far better across several dimensions. Optimists tend to have better self-esteem and
less hostility toward others and tend to use more adaptive coping strategies than pessimists.
Optimism is a significant predictor of coping efforts and of recovery from surgery.
Individuals with optimistic orientations have a faster rate of recovery during hospitalization and a
faster rate of return to normal life activities after discharge. There was also a strong relationship
between optimism and postsurgical quality of life, with optimists doing better than pessimists.
Optimism may reduce symptoms and improve adjustment to illness, because it is associated with
the use of effective coping strategies. This same analogy can be extended to impairment.
Optimistic individuals are more likely to cope with impairment by using the active adaptive
coping strategies discussed earlier. These in turn will lead to reduced disability.
The four constructs of the psychological environment (i.e., self-efficacy beliefs,
psychological control, coping patterns, and optimism) were highlighted to illustrate the influence
of these factors on disability and the enabling-disabling process. These psychological constructs
are interrelated and are influenced to a large extent by the external social and physical
environments. The reason for the inclusion of the psychological
environment in this topic is to assert that just as the physical and social environments can be
changed to support people with disabling conditions, so can the psychological environment.
Psychological interventions directed at altering cognition lead to improved outcomes (i.e.,
achievement, interpersonal relationships, work productivity, and health) across diverse
populations and dimensions.
The Family and Disability
The family can be either an enabling or a disabling factor for a person with a disabling condition.
Although most people have a wide network of friends, the networks of people with disabilities are
more likely to be dominated by family members. Even among people with disabilities who
maintain a large network of friends, family relationships often are most central and families often
provide the main sources of support. This support may be instrumental (errand-running),
informational (providing advice or referrals), or emotional (giving love and support).
Families can be enabling to people with functional limitations by providing such tangible
services as housekeeping and transportation and by providing personal assistance in activities of
daily living. Families can also provide economic support to help with the purchase of assistive
technologies and to pay for personal assistance. Perhaps most importantly, they can provide
emotional support. Emotional support is positively related to well-being across a number of
conditions. In all of these areas, friends and neighbors can supplement the support provided by the
family.
It is important to note, however, that families may also be disabling. Some families
promote dependency. Others fatalistically accept functional limitations and conditions that are
amenable to change with a supportive environment. In both of these situations, the person with the
potentially disabling condition is not allowed to develop to his or her fullest potential. Families
may also not provide needed environmental services and resources. For example, families of deaf
children frequently do not learn to sign, in the process impeding their children's ability to
communicate as effectively as possible. Similarly, some well- meaning families prematurely take
over the household chores of people with angina, thereby limiting the opportunity for healthy
exercise that can lead to recovery.
Needs of Persons with Disabilities and Vulnerabilities.
Needs of persons with disabilities and vulnerabilities depends on different factors.
People with disabilities do not all share a single experience, even of the same impairment;
likewise, professionals in the same discipline (sector)do not follow a single approach or hold the
same values. Exciting new directions will arise from individual professionals (sectors) working
with persons with disabilities and vulnerabilities on particular briefs. This will produce different
responses each time, complementary and even contradictory directions, but this richness is
needed.
Analyzing the human beings, Maslow has identified five categories of needs, with
different priority levels (Fig. 3.1), in the following order: survival (physiological), safety, social
needs, esteem, and self-actualization (fulfillment). Maslow‘s model is also valid for persons with
disabilities and vulnerabilities, whose needs are similar to those of ordinary persons. Nevertheless,
many of these needs are not fulfilled, so disabilities and vulnerabilities seek to fulfill these needs
and reach a state of wellbeing. Initially, disabilities and vulnerabilities attempt to fulfill the first
level of needs (survival). The survival needs are formed by the physiological needs and include
the biological requirements for feeding, performing hygiene, sleeping, ADL, and so on. When
disabilities and vulnerabilities fulfill their survival needs, they will look for situations that keep
them safe, before moving up the chain and fulfill their needs to be part of society and to achieve.
As an example of needs in terms of safety, consider a person with visual impairment who wishes
to cross the street safely. In contrast, for the elderly, at risk and street children safety might
represent the ability to obtain emergency help after falling and not being able to stand again.
Social need is a key element that disabilities and vulnerabilities would like to develop
continuously. For example, a person with a hearing impairment suffers from a diminution of
social contact, while someone with a motor disability feels excluded from social activities.
The third level of the pyramid relates to esteem, both self-esteem and being favorably
recognized by others. Esteem is often related to the capability of achieving things, contributing to
a work activity and being autonomous. In particular, disabilities and
vulnerabilities in a dependent situation feel the need for increased autonomy, as well as the
opportunity to prove their worth to themselves and others through work or other activities.
 Fig.3.1 Abraham‘s Maslow Hierarchy
Persons with disabilities and vulnerabilities have socio-emotional, psychological,
physical and social environmental and economic needs in general. The following list but not last
are basic needs of persons with disabilities and vulnerabilities to ensure equality for all within
our society.
a) Full access to the Environment (towns, countryside & buildings)
b) An accessible Transport system
c) Technical aids and equipment
d) Accessible/adapted housing
e) Personal Assistance and support
f) Inclusive Education and Training
g) An adequate Income
h) Equal opportunities for Employment
i) Appropriate and accessible Information
j) Advocacy (towards self-advocacy)
k) Counseling
l) Appropriate and Accessible Health Care
Social Needs of Persons with Disabilities and Vulnerabilities
Social protection plays a key role in realizing the rights of persons with disabilities and
vulnerabilities of all ages: providing them with an adequate standard of living, a basic level of
income security; thus reducing levels of poverty and vulnerability. Moreover, mainstream and/or
specific social protection schemes concerning persons with disabilities can have a major role
in promoting their independence and inclusion by meeting their specific needs and supporting
their social participation in a non-discriminatory manner. These social protection measures may
include poverty reduction schemes; cash transfer programs, social and health insurance, public
work programs, housing programs, disability pensions and mobility grants. Social protection from
a rights-based approach must accommodate the needs of persons with disabilities and
vulnerabilities. Traditional disability-related social welfare schemes have mainly focused on
poverty rather than taking into account specific challenges faced by persons with disabilities
and vulnerabilities; particularly active participation in education, access to health and
employment. Previous methods of addressing benefits for persons with disabilities have shown
limited progress in overcoming the deeply-rooted social structures and practices that hinder
opportunities for persons with disabilities. Consequently, social protection needs to move
beyond traditional welfare approaches to intervention systems that promote active citizenship,
social inclusion and community participation while avoiding paternalism and dependence.
The right of persons with disabilities to social protection is recognized by the 1948
Universal Declaration of Human Rights (UDHR), the 1966 International Covenant on Economic,
Social and Cultural Rights (ICESCR) and, more specifically, the 2006 UN Convention on the
Rights of Persons with Disabilities (CRPD). Article 28 of the CRPD in particular recognizes the
right of persons with disabilities to an adequate standard of living and to social protection,
ensuring the enjoyment of both rights without discrimination on the basis of ability. Therefore,
States parties should take appropriate measures to ensure that they
receive equal access to mainstream social protection programs and services —including basic
services, social security systems, poverty reduction programs and housing programs— but also
specific programs and services for disability-related needs and expenses.
Furthermore, the Social Protection Floors Recommendation (No. 202) recognizes the importance
of national social protection floors to provide basic social security guarantees to all persons,
including persons with disabilities and vulnerabilities, across the life cycle (with priority given to
poverty, vulnerability, and social exclusion).
Gender and disability
The importance of work and the daily activities required of living in the country are paramount in
considering gender. For the male and female with disabilities and vulnerable groups, work is
universally seen as important, whether paid work or voluntary. When the work interests of men
with disabilities are similar to those of others around them, their identity as a ‗man‘ becomes
more valuable to the community. However, there are issues around how masculinity in rural areas
is constituted. Finding ways to express this through involvement in common activities can be
difficult. Many of male and females with disabilities have creativity and skill in finding ways to
do things and consequently being able to build friendships with other men in their communities.
Work, particularly paid work, is also important for many of the female contributors.
Sustaining this in the face of community views about disability is at times difficult, particularly
when it is balanced with expectations of traditional women‘s roles of home making and childcare.
Being excluded from these latter tasks because of others‘ protective or controlling views is
particularly difficult for some women in asserting their identities as women and exploring these
types of gendered practices.
Identity and disability
The relational nature of identity seems to be of central importance to people with disabilities and a
rural environment in some instances provides a different way for people to be perceived by others
and by themselves. People with disabilities are not primarily clients or service users but rather are
known members of their communities with a shared and, at times,
intergenerational history. The formality of the service system is counterpointed by the
relationships people formed with those who share a rural life.
Identity marked by disability is complex and multilayered; relationships, outside of paid,
formalized service settings. Services are facilitators of a rural life, rather than the focus of rural
life itself. New technologies, determination and interests shape differing identities for people who
are active agents in their own lives.
This is not to argue that rural living is an idyll for people with disabilities. For some, their
interests and aspirations are elsewhere and they may be constrained by the necessity of living
rurally either because of the needed support from families or a personal need for the refuge of
rural living in times of difficulty. Such difficulties are often generated by broader structural
relations of being socially identified as ‗disabled‘, such as with the onset of new austerity
measures.
Disability as part of an individual‘s identity is seen by some as a struggle. This is
often twofold: internally to individuals and their sense of self and, too often, in the way they are
perceived and constructed by those around them. An acquired disability is experienced as
challenging the nature of one‘s internal pre-established identity and as a struggle to change the
perceptions and attitudes of others and the physical environment in which a person lives. Relations
with family, friends and communities often provided a contradictory landscape, where a person
has to negotiate his or her new disabled identity yet, at the same time, is able to draw upon
previous shared experiences to become re-embedded in friendships and communities. Finding
ways to gain ‗value‘ in the local community with a disability is an ongoing and, too often,
difficult journey. It is these very journeys that create one‘s identity and the relational nature of this
identity to the rural landscape.
Belongingness and disability
Belonging is a complex concept involving an attachment to place, relationships with others, a
sense of safety, common values and a shared and/or developing history. Belonging is also an
internal sense of being at home in one‘s own body and mind. Persons with disabilities and
vulnerable groups have struggled to come to terms with a body and mind which seem unfamiliar
to them, in which they have to make adjustments or accommodations both for themselves and in
terms of their relationships with others. This internal negotiation and navigation shape their
engagement with their social worlds, particularly in rural communities.
Persons with disabilities in rural areas should have a strong attachment to place,
somewhere familiar and known where they can feel safe, find their ways alone, exercise autonomy
and express their embodied selves. The possibility of making change happen in an environment,
where one‘s voice is heard, is also seen as a part of belonging in a community. While this is
sometimes a struggle, there is a sense that people can use their personal contacts and friends to get
change to happen when it is needed.
Family relationships as a means of connecting to community and being known by others,
and knowing others outside the family are important. Different kinds of relationship contributed to
this sense of belonging, ranging from the more superficial nodding acquaintances to specific
informal support from known others, to the intimacy of close friends and kin.
Historically for people with disabilities, rurality was once the site of exclusion, rather than
belonging, where identity and gender were disregarded in favor of ensuring protection of people
with disabilities and of the society in which they lived. The idea of belonging in a rural landscape
was promoted by people with a vested interest in segregation.
People with disabilities and marginalized groups feel isolated. Some persons with disabilities have
actively sought to migrate to urban environments, to escape from the confines and constraints of
small rural environments and to build broader social networks away from the farm.
3.2.1.4 Intersectionality
Social structures and norms surrounding age are particularly significant, shaping the kind of lives
people have and their experience of gender and identity. They have particular implications for
people‘s attachment to place and their aspirations and desires for the future. Age matters, too, in
terms of the support that family and services can offer in a rural environment and the types of
‗age-appropriate‘ opportunities that can be facilitated in the person‘s home, family and
community. Being a particular ‗age‘ in a rural landscape has implications for the types of social
relationship that are openly facilitated and enabled.
The wider contextual values and economic and social changes have also impact on the
life of persons with disabilities. Religious values that shape the way disability is constituted in
some countries are a powerful influence on the way people with disabilities are able to live their
lives. These values intersect with societal expectations of gender roles. Many peoples with
disabilities are subjected to being viewed as objects of pity and prevailing
myths about their capacities, socially and individually. These social myths are key sites of struggle
and, as suggested earlier, are deeply intertwined with a person‘s own subjective understandings of
gendered identities and sense of belonging as a person with a disability.
Economic changes which have led to mass migration from the rural to the urban and
increased the emphasis on citizens‘ economic contribution to society have also had an impact on
rural living for some people. Further, structural changes, such as austerity and welfare retraction,
in some countries have created unique pressures on some people with disabilities living in rural
areas. These places may provide a space to ‗hide‘, a place where one is known and familiar, and
where one is sheltered from the negative attitudes that accompany government cutbacks. Such
prevailing economic constraints also lead to new forms of isolation. The constant pressure to
‗present‘ in an acceptable way to the people one knows and, at the same time, to continue to
qualify for the benefits one needs has added a new form of stress to rural living not previously
experienced by many people with disabilities. The experience of having a disability and not being
on welfare is significantly different to that of people with disabilities whose economic security
depends on what has become highly stigmatized support. The management of the self and of rural
social relationships intersects deeply with these broader structural changes, and navigating such
structural continuities and disruptions is a critical influence on the lives of people with disabilities.
Poverty has impact on living a decent life with a disability in a rural landscape, a life that
they have defined and desired. In a number of cases this is centered on the need for paid work and
the difficulties in finding it where employment is often scarce or highly exclusionary due to
farming practices. Some contributors emphasize the importance of familial social networks and
the additional support these provide, alongside belonging to a community where one is known, in
enabling people with disabilities to counter the negative aspects of poverty. Given the changing
welfare environment, including the growing insecurity of disability support landscapes, many of
the contributors express fears of the future. Particular concerns are the very real possibility of a
time when services or family support may not be available, alongside the impact of diminished
access to social security with the onset of austerity.
The Health Care Needs of Persons with Disabilities and Vulnerabilities
People with disabilities report seeking more health care than people without disabilities and have
greater unmet needs. For example, a recent survey of people with serious mental
disorders, showed that between 35% and 50% of people in developed countries, and between 76%
and 85% in developing countries, received no treatment in the year prior to the study.
Health promotion and prevention activities seldom target people with disabilities. For
example women with disabilities receive less screening for breast and cervical cancer than women
without disabilities. People with intellectual impairments and diabetes are less likely to have their
weight checked. Adolescents and adults with disabilities are more likely to be excluded from sex
education programs.
People with disabilities are particularly vulnerable to deficiencies in health care services.
Depending on the group and setting, persons with disabilities may experience greater vulnerability
to secondary conditions, co-morbid conditions, age-related conditions, engaging in health risk
behaviors and higher rates of premature death.
A) Secondary conditions: conditions occur in addition to (and are related to) a primary
health condition, and are both predictable and therefore preventable. Examples include
pressure ulcers, urinary tract infections, osteoporosis and pain.
B) Co-morbid conditions: conditions occur in addition to (and are unrelated to) a primary
health condition associated with disability. For example the prevalence of diabetes in
people with schizophrenia is around 15% compared to a rate of 2-3% for the general
population.
C) Age-related conditions: The ageing process for some groups of people with disabilities
begins earlier than usual. For example some people with developmental disabilities show
signs of premature ageing in their 40s and 50s.
D) Engaging in health risk behaviors: Some studies have indicated that people with
disabilities have higher rates of risky behaviors such as smoking, poor diet and physical
inactivity.
Barriers to Health Care for Persons with Disabilities and Vulnerable Groups
People with disabilities encounter a range of barriers when they attempt to access health care
including the following.
a) Prohibitive costs: Affordability of health services and transportation are two main reasons
why people with disabilities do not receive needed health care in low-income countries -
32-33% of non-disabled people are unable to afford health care compared to 51-53% of
people with disabilities.
b) Limited availability of services: The lack of appropriate services for people with
disabilities is a significant barrier to health care. For example, studies indicate that the lack
of services especially in the rural area is the second most significant barrier to using health
facilities.
c) Physical barriers: Uneven access to buildings (hospitals, health centers), inaccessible
medical equipment, poor signage, narrow doorways, internal steps, inadequate bathroom
facilities, and inaccessible parking areas create barriers to health care facilities. For
example, women with mobility difficulties are often unable to access breast and cervical
cancer screening because examination tables are not height-adjustable and mammography
equipment only accommodates women who are able to stand.
d) Inadequate skills and knowledge of health workers: People with disabilities were more
than twice as likely to report finding health care provider skills inadequate to meet their
needs, four times more likely to report being treated badly and nearly three times more
likely to report being denied care.
Addressing for Inclusive Barriers to Health Care
Governments and professionals can improve health outcomes for people with disabilities by
improving access to quality, affordable health care services, which make the best use of available
resources. As several factors interact to inhibit access to health care, reforms in all the interacting
components of the health care system are required.
a) Policy and legislation: Assess existing policies and services, identify priorities to reduce
health inequalities and plan improvements for access and inclusion. Make changes to
comply with the CRPD. Establish health care standards related to care of persons with
disabilities with enforcement mechanisms.
b) Financing: Where private health insurance dominates health care financing, ensure that
people with disabilities are covered and consider measures to make the premiums
affordable. Ensure that people with disabilities benefit equally from public health care
programs. Use financial incentives to encourage health-care providers to make services
accessible and provide comprehensive assessments, treatment, and follow- ups. Consider
options for reducing or removing out-of-pocket payments for people with disabilities who
do not have other means of financing health care services.
c) Service delivery: Provide a broad range of modifications and adjustments (reasonable
accommodation) to facilitate access to health care services. For example changing the
physical layout of clinics to provide access for people with mobility difficulties or
communicating health information in accessible formats such as Braille. Empower people
with disabilities to maximize their health by providing information, training, and peer
support. Promote community-based rehabilitation (CBR) to facilitate access for disabled
people to existing services. Identify groups that require alternative service delivery models,
for example, targeted services or care coordination to improve access to health care.
d) Human resources: Integrate disability inclusion education into undergraduate and
continuing education for all health-care professionals. Train community workers so that
they can play a role in preventive health care services. Provide evidence-based guidelines
for assessment and treatment.
Disability, vulnerability and the Environment
The prevailing understanding about the cause of disability has undergone profound change
worldwide. Previous models of absolute determinism that viewed pathology and disability
interchangeably and that excluded consideration of the environment have been replaced by models
in which disability is seen to result from the interaction between the characteristics of individuals
with disabilities and the characteristics of their environment. Cultural norms affect the way
that the physical and social environments of the individual are constituted and then focus on a few
—but not all—of the elements of the environment to provide examples of
how the environment affects the degree of disability. The amount of disability is not determined
by levels of pathologies, impairments, or functional limitations, but instead is a function of the
kind of services provided to people with disabling conditions and the extent to which the physical,
built environment is accommodating or not accommodating to the particular disabling condition.
Because societies differ in their willingness to provide the available technology and, indeed, their
willingness to provide the resources to improve that technology, disability ultimately must been
seen as a function of society, not of a physical or medical process.
Disability is not inherent in an individual but is, rather, a relational concept—a function of
the interaction of the person with the social and physical environments. The amount of disability
that a person experiences, depends on both the existence of a potentially disabling condition (or
limitation) and the environment in which the person lives. For any given limitation (i.e., potential
disability), the amount of actual disability experienced by a person will depend on the nature of
the environment, that is, whether the environment is positive and enabling (and serves to
compensate for the condition, ameliorate the limitation, or facilitate one's functional activities) or
negative and disabling (and serves to worsen the condition, enhance the limitation, or restrict one's
functional activities). Human competencies interact with the environment in a dynamic reciprocal
relationship that shapes performance. When functional limitations exist, social participation is
possible only when environmental support is present. If there is no environmental support, the
distance between what the people can do and what the environment affords creates a barrier that
limits social participation.
The physical and social environments comprise factors external to the individual, including
family, institutions, community, geography, and the political climate. Added to this
conceptualization of environment is one's intrapersonal or psychological environment, which
includes internal states, beliefs, cognition, expectancies and other mental states. Thus,
environmental factors must be seen to include the natural environment, the human made
environment, culture, the economic system, the political system, and psychological factors.
Some Enabling and Disabling Factors in the Physical Environment
Type of Type of Environment
Factor
Natural Environment Built Environment
Dry climate Ramps
Enabling

Flat terrain Adequate lighting

Clear paths Braille signage
Snow Steps
Disabling

Rocky terrain Low-wattage lighting

High humidity Absence of flashing light alerting systems

The environmental mat may be conceived of as having two major parts: the physical environment
and the social and psychological environments. The physical environment may be further
subdivided conceptually into the natural environment and the built environment. Both affect the
extent to which a disabling condition will be experienced by the person as a disability.
Three types of attributes of the physical environment need to be in place to support human
performance. The first attribute is object availability. Objects must be in a location that is useful,
at a level where they can be retrieved, and must be organized to support the performance of the
activity. Neither a sink that is too high for a wheelchair user nor a telecommunications device for
the deaf (TDD) that is kept at a hotel reception desk is available. The second attribute is
accessibility. Accessibility is related to the ability of people to get to a place or to use a device.
Accessibility permits a wheelchair user to ride a bus or a Braille user to read a document. The
third attribute is the availability of sensory stimulation regarding the environment. Sensory
stimulation, which can include visual, tactile, or auditory cues, serves as a signal to promote
responses. Examples of such cues could include beeping microwaves, which elicit responses from
people without hearing impairments, or bumpy surfaces on subway platforms, which tell users
with visual impairments to change their location.
A) The Natural Environment
The natural environment may have a major impact on whether a limitation is disabling. For
example, a person who has severe allergies to ragweed or mold, which can trigger disabling
asthma, can be free of that condition in climates where those substances do not grow. The physical
conditions still exist, but in one environment they may become disabling and in another
environment they might not. Another example might be that a person who has limited walking
ability will be less disabled in a flat geographical location than he disabled in both places during
the winter than during the summer. Thus, the natural environment, including topography and
climate, affect whether or to what degree a functional limitation will be disabling.
B) The human made Environment
The physical environment is a complex interaction of built-in objects. Built objects are created and
constructed by humans and vary widely in terms of their complexity, size, and purpose. Built
objects are created for utilitarian reasons and also for an outlet for creativity. For instance, built
objects such as dishwashers and computers have the potential to enhance human performance or to
create barriers.
Rural environment, Disability and Vulnerability
This topic focus on rural environment and life of persons with disabilities, vulnerabilities and
marginalized groups, how rural landscapes, infrastructure and communities shaped social
understandings of disability, and how these understandings might uniquely shape opportunities a
better life of this group of people. People with disabilities, vulnerabilities and marginalized groups
have no voices about their lives and what rural living means to them. Physical landscapes are
infused with social meaning and that the feelings we have for particular places are built up through
an accumulation of experiences that invoke strong emotional responses. Rurality must be
considered as more than an issue of context or setting. Instead, rurality professionals in rural
should prioritize the voices and experiences of
those who live rurally, and that the specific characteristics or aspects of the particular rural
communities to which they belong.
Since larger population of Ethiopia (more than 85%) are agricultural community, life and
aspirations of disabilities and vulnerable groups highlight both the pull and the push of rural living
without appropriate services and supports.
Persons with disabilities, vulnerable and marginalized groups living in rural areas have double
disadvantaged due to their impairments and vulnerabilities and unfavorable physical and social
environment. Professional who are working in rural areas should work in collaboration
accordingly. More specifically, these group of people have been excluded from agricultural works
(productivity) due its nature high demand to labour and lack of technologies and well organized
support from professional.
Creating Welcoming (Inclusive) Environment
External environmental modifications can take many forms. These can include assistive devices,
alterations of a physical structure, object modification, and task modification. The role of
environmental modification as a prevention strategy has not been systematically evaluated, and its
role in preventing secondary conditions and disability that accompany a poor fit between human
abilities and the environment should be studied. Environmental strategies may ease the burden of
care experienced by a family member who has the responsibility of providing the day-to-day
support for an individual who does not have the capacity for social participation and independent
living in the community. These environmental modifications may well be an effort at primary
prevention because the equipment may provide a safety net and prevent disabling conditions that
can occur through lifting and transfer of individuals who may not be able to do it by themselves.
Rehabilitation must place emphasis on addressing the environmental needs of people with
disabling conditions. Environmental strategies can be effective in helping people function
independently and not be limited in their social participation, in work, leisure or social interactions
as a spouse, parent, friend, or coworker.
Examples of Environmental Modification
1. Mobility aids
 Hand Orthosis
 Mouth stick
 Prosthetic limb
 Wheelchair (manual and/or motorized)
 Canes
 Crutches
 Braces
2. Communication aids
 Telephone amplifier or TDD
 Voice-activated computer
 Closed or real-time captioning
 Computer-assisted note taker
 Print enlarger
 Reading machines
 Books on tape
 Sign language or oral interpreters
 Braille writer
 Cochlear implant
 Communication boards FM, audio-induction loop, or infrared systems
3. Accessible structural elements
 Ramps Elevators
 Wide doors
 Safety bars
 Nonskid floors
 Sound-reflective building materials
 Enhanced lighting
 Electrical sockets that meet appropriate reach ranges
 Hardwired flashing alerting systems Increased textural contrast
4. Accessible features
 Built up handles
 Voice-activated computer
 Automobile hand controls
5. Job accommodations
 Simplification of task
Flexible work hours
Rest breaks
Splitting job into parts
Relegate nonessential functions to others
6.
Differential use of personnel
Personal care assistants
Note takers
Secretaries Editors
Sign language interpreters
3.3.1.1.1 Impact of the Social and Psychological Environments on the Enabling-Disabling
Process
The social environment is conceptualized to include cultural, political, and economic factors. The
psychological environment is the intrapersonal environment. This section examines how both
affect the disabling process.
Culture and the Disabling Process
Culture affects the enabling-disabling process at each stage; it also affects the transition from one
stage to another. This section defines culture and then considers the ways in which it affects each
stage of the process.
Definition of Culture
Definition of culture includes both material culture (things and the rules for producing them) and
nonmaterial culture (norms or rules, values, symbols, language, ideational systems such as science
or religion, and arts such as dance, crafts, and humor). Nonmaterial culture is so comprehensive
that it includes everything from conceptions of how many days a week has or how one should
react to pain to when one should seek medical care or whether a hermaphroditic person is an
abomination, a saint, or a mistake. Cultures also specify punishments for rule-breaking,
exceptions to rules, and occasions when exceptions are
permitted. The role of nonmaterial culture for humans has been compared to the role of instincts
for animals or to the role of a road map for a traveler. It provides the knowledge that permits
people to be able to function in both old and new situations.
Both the material and nonmaterial aspects of cultures and subcultures are relevant to the enabling-
disabling process. However, for our purpose we will focus primarily on the role of nonmaterial
culture in that process. Cultures have an impact on the types of pathologies that will occur as well
as on their recognition as pathologies.
However, if a pathology is not recognized by the culture (in medical terms, diagnosed), the
person does not begin to progress toward disability (or cure).
Enabling and Disabling Factors

Element of Social and Psychological Environment

Type of
Factor

Culture Psychological Political Economic

Expecting people Having an active Mandating relay Tax credits to hire people with
with disabling coping strategy systems in all states disabling conditions
conditions to be
Enabling

productive
Expecting everyone Cognitive Banning discrimination Targeted earned income tax
to know sign restructuring against people who can credits
language perform the essential
functions of the job
 Stigmatizing people Catastrophizing Segregating children Economic disincentives to get
with disabling with mobility off Social Security Disability
Disabling

conditions impairments in schools Income benefits

Valuing physical Denial Voting against No subsidies or tax credits for

beauty paratransit system purchasing assistive technology
Pathway from Pathology to Impairment to Functional Limitation
Culture can affect the likelihood of the transition from pathology to impairment. A subculture,
such as that of well-educated society, in which health advice is valued, in which breast cancer
screening timetables are followed, and in which early detection is likely, is one
in which breast tumors are less likely to move from pathology to impairments. In a subculture in
which this is not true, one would likely see more impairments arising from the pathologies.
Cultures can also speed up or slow down the movement from pathology to impairment,
either for the whole culture or for subgroups for whom the pathway is more or less likely to be
used. For example, some religions, women are less likely to seek health care because it means a
man must be available to escort them in public, which is unlikely if the males are breadwinners
and must give up income to escort them, and women are also less likely to seek health care if the
provider is male. Thus, their culture lessens the likelihood that their pathology will be cured and
therefore increases the likelihood that the pathology will become impairment.
Culture clearly has an impact on whether a particular impairment will become a functional
limitation. Impairments do not become limiting automatically. Rather, cultures affect the
perception that the impairment is in fact the cause of the limitation, and they affect the perception
that the impairment is in fact limiting.
If a society believes that witchcraft is the reason that a woman cannot have children,
medical facts about her body become irrelevant. She may in fact have fibroids, but if that culture
sees limitation as coming from the actions of a person, there is no recognition of a linkage
between the impairment and the functional limitation. Rather, any enabling-disabling process must
go through culturally prescribed processes relating to witches; medically or technologically based
enabling-disabling processes will not be acceptable.
If the culture does not recognize that impairment is limiting, then it is not. For example,
hearing losses were not equivalent to functional limitations in Martha's Vineyard, because
"everyone there knew sign language". Or, if everyone has a backache, it is not defined by the
culture as limiting. There are many cross-cultural examples. In a culture in which nose piercing is
considered necessary for beauty, possible breathing problems resulting from that pathology and
impairment would be unlikely to be recognized as being limiting. Or, in a perhaps more
extreme case, female circumcision is an impairment that could lead to functional limitation
(inability to experience orgasm), but if the whole point is to prevent female sexual arousal and
orgasm, then the functional limitation will not be
recognized within that culture but will only be recognized by those who come from other cultures.
In all these examples, if the culture does not recognize the impairment, the rehabilitation process
is irrelevant—there is no need to rehabilitate a physical impairment if there is no recognized
functional limitation associated with it.
Pathway from Functional Limitation to Disability
Here, the most important consideration is the ways in which the transition from functional
limitation to disability is affected by culture. A condition that is limiting must be defined as
problematic—by the person and by the culture—for it to become a disability. Whether a
functional limitation is seen as being disabling will depend on the culture. The culture defines the
roles to be played and the actions and capacities necessary to satisfy that role. If certain actions are
not necessary for a role, then the person who is limited in ability to perform those actions does not
 have a disability. For example, a professor who has arthritis in her hands but who primarily
lectures in the classroom, dictates material for a secretary to type, and manages research assistants
may not be disabled in her work role by the arthritis. In this case, the functional limitation would
not become a disability. For a secretary who would be unable to type, on the other hand, the
functional limitation would become a disability in the work sphere.
A disability can exist without functional limitation, as in the case of a person with a facial
disfigurement living in cultures such as that in the United States, whose standards of beauty
cannot encompass such physical anomalies. Culture is thus relevant to the existence of
disabilities: it defines what is considered disabling. Additionally, culture determines in which roles
a person might be disabled by a particular functional limitation. For example, a farmer in a small
village may have no disability in work roles caused by a hearing loss; however, that person may
experience disabilities in family or other personal relationships. On the other hand, a profoundly
deaf, signing person married to another profoundly deaf, signing person may have no disability in
family-related areas, although there may be a disability in work-related areas. Thus, culture affects
not just whether there is a disability caused by the functional limitation but also where in the
person's life the disability will occur. Culture is therefore part of the mat; as such, it can protect a
person from the disabling process and can slow it down or speed it up. Culture, however, has a
second function in the disabling process.
Although there is a direct path from culture to disability, there is an also indirect path. The
indirect function acts by influencing other aspects of personal and social organization in a
society. That is, the culture of a society or a subculture influences the types of personality or
intrapsychic processes that are acceptable and influences the institutions that make up the social
organization of a society. These institutions include the economic system, the family system, the
educational system, the health care system, and the political system. In all these areas, culture sets
the boundaries for what is debatable or negotiable and what is not. Each of these societal
institutions also affects the degree to which functional limitations will be experienced by
individuals as disabling.
All of the ways in which intrapsychic processes or societal institutions affect the enabling-
disabling process cannot be considered here. However, the remainder of this section presents some
examples of how the enabling-disabling process can be affected by three factors: economic,
political, and psychological.
Disability Inclusive Intervention and Rehabilitation Services
A „One-size-fits-all‟ approach to provide services for persons with disabilities and
vulnerability groups is no longer enough.
Including people with disabilities in everyday activities and encouraging them to have roles similar to peoples who
do not have a disability is disability inclusion. This involves more than simply encouraging people; it requires
making sure that adequate policies and practices are in effect in a community or organization. Inclusion should lead
to increased participation in socially expected life roles and activities—such as being a student, worker, friend,
community member, patient, spouse, partner, or parent. Disability inclusion means provision of differentiated
services for persons with disabilities and vulnerabilities. Differentiated service means a multiple service delivery
model that can satisfy the most needs of persons with disabilities and vulnerabilities. Socially expected activities
may also include engaging in social activities, using public resources such as transportation and libraries, moving
about within communities, receiving adequate health care, having relationships, and enjoying other day-to-day
activities. To reach ambitious targets for the general population, as well as targeted care for persons with disabilities
and vulnerable groups, we need differentiated service delivery.
Persons with disabilities and vulnerabilities are often excluded (either directly or
indirectly) from development processes and humanitarian action because of physical, attitudinal
and institutional barriers. The effects of this exclusion are increased inequality, discrimination and
marginalization. To change this, a disability inclusion approach must be implemented. The twin-
track approach involves: (1) ensuring all mainstream programs and services are inclusive and
accessible to persons with disabilities, while at the same time (2) providing targeted disability-
specific support to persons with disabilities.
The two tracks reinforce each other. When mainstream programs and services, such as health and
education services, are disability-inclusive and aware, this can help facilitate both prevention of
impairments, as well as early identification of children and persons with disabilities who can then
be referred to disability-specific services. And the provision of disability-specific supports, such
as assistive devices, can help facilitate more effective inclusion of persons with disabilities in
mainstream services.
Strategies to Disability inclusive intervention and rehabilitation
Prevention
Prevention of conditions associated with disability and vulnerability is a development issue.
Attention to environmental factors – including nutrition, preventable diseases, safe water and
sanitation, safety on roads and in workplaces – can greatly reduce the incidence of health
conditions leading to disability. A public health approach distinguishes:
i) Primary prevention – actions to avoid or remove the cause of a health problem in an
individual or a population before it arises. It includes health promotion and specific
protection (for example, HIV education).
ii) Secondary prevention (early intervention) – actions to detect a health and disabling
conditions at an early stage in an individual or a population, facilitating cure, or reducing
or preventing spread, or reducing or preventing its long-term effects (for example,
supporting women with intellectual disability to access breast cancer screening).
iii) Tertiary prevention (rehabilitation) – actions to reduce the impact of an already
established disease by restoring function and reducing diseaserelated complications (for
example, rehabilitation for children with musculoskeletal impairment).
Primary prevention issues are consider as crucial to improved overall health of countries‘
populations. Viewing disability as a human rights issue is not incompatible with prevention of
health conditions as long as prevention respects the rights and dignity of people with disabilities,
for example, in the use of language and imagery. Preventing disability and vulnerability should be
regarded as a multidimensional strategy that includes prevention of disabling barriers as well as
prevention and treatment of underlying health conditions.
Implementing the Twin-track Approach
Implementing the twin-track approach involves: Track 1: Mainstreaming disability as a cross-
cutting issue within all key programs and services (education, health, relief and social services,
microfinance, infrastructure and camp improvement, protection, and emergency response) to
ensure these programs and services are inclusive, equitable, non-discriminatory, and do not create
or reinforce barriers.
This is done by: gathering information on the diverse needs of persons with disabilities
during the assessment stage; considering disability inclusion during the planning stage; making
adaptations in the implementation stage; and gathering the perspectives of persons with disabilities
in the reporting and evaluation stage.
Track 2: Supporting the specific needs of vulnerable groups with disabilities to ensure they
have equal opportunities to participate in society. This is done by strengthening referral to both
internal and external pathways and ensuring that sector programs to provide rehabilitation,
assistive devices and other disability-specific services are accessible to persons with disabilities
and vulnerable groups and adhere to protection standards and inclusion principles. A Sector‘s
organizational structures and human resources on disability inclusion should aim to reflect this
twin-track approach. In particular, each sector should have disability program officers in all fields
working to implement disability-specific support activities.
Implement Disability Inclusive Project/ Program
As a direct service provider, consultant and materials and equipment producers concerned with
realizing equity, quality services and protecting human rights, all sectorial strategies, program,
projects and services must be disability-inclusive. The sectors operations should be largely framed
within broad programs, making it very important to ensure that disability
inclusion is reflected in program strategies and design documents. This in turn will help to
subsequently ensure disability is also incorporated into the projects that are designed to contribute
to the overall program objectives. However, persons with disabilities are often not considered in
crucial stages of most sectorial and developmental program and projects because of lack of
awareness about the characteristics of people with disabilities, vulnerability groups and disability
inclusion in practice.
The following tips will help to overcome the challenges as a key considerations for including
persons with disabilities in all program and project cycle management stages of Assessment,
Planning, Implementation and Monitoring, and Reporting/Evaluation.
A) Education and vocational training –Inclusive Educationrealize the universal right to
education for all, meaning all mainstream education services need to be supporting children
and persons with disabilities.
B) Health – vulnerable groups and persons with disabilities have the same health-care needs as
all other peoples and health sector services can also play an important prevention and early
identification role to ensure children and persons with impairments have timely access to
health services and referral rehabilitation support.
C) Relief and social services – the two-way link between poverty and disability means that
vulnerable group and peoples with disabilities and their families need to be able to access
relief support.
D) Infrastructure and camp improvement, shelter, water and sanitation and environmental
health – universal design concepts must be considered in all infrastructure and
construction programs and projects.
E) Livelihoods, employment and microfinance – vulnerable groups and people with
disabilities face numerous barriers to achieving an independent livelihood, it is crucial that
specific sectors responsible for livelihood programs and projects to make accessible to all
vulnerable and people with disabilities.
F) Protection – marginalized groups and people with disabilities may face risks and
vulnerabilities to experiencing violence, exploitation, abuse, neglect and violation of rights
and therefore need to be specifically considered and included in protection programs and
projects.
G) Humanitarian and emergency response – the disproportionate effect of emergency and
humanitarian situations on vulnerable groups and people with disabilities should be reflected
in the design and implementation of the humanitarian projects.
Implement effective Intervention and Rehabilitation
Rehabilitation interventions promote a comprehensive process to facilitate attainment of
the optimal physical, psychological, cognitive, behavioral, social, vocational, avocational, and
educational status within the capacity allowed by the anatomic or physiologic impairment,
personal desires and life plans, and environmental (dis)advantages for a person with a disability.
Consumers/patients, families, and professionals work together as a team to identify
realistic goals and develop strategies to achieve the highest possible functional outcome, in some
cases in the face of a permanent disability, impairment, or pathologic process. Although
rehabilitation interventions are developed within medical and health care models, treatments are
not typically curative. Professionals have the knowledge and background to anticipate outcomes
from the interventions, with a certain degree of both optimism and cynicism, drawn from past
experiences.
Rehabilitation requires goal-based activities and, more recently, measurement of
outcomes. The professionals, usually with the patient/ consumer and/or family, develop goals of
the interventions to help mark progress or identify the need to reassess the treatment plan. Broad
goals and anticipated outcomes should include increased independence, prevention of further
functional losses or additional medical conditions when possible, improved quality of life, and
effective and efficient use of health care systems. Consideration of accessibility of environments
and social participation can, and increasingly should, be included within the scope of outcomes
and goals for independence. A broad range of measurement tools have been developed for use
within rehabilitation, and these standardized tools, along with objective measures of performance
(e.g., distance walked, ability to perform a task independently), are typically documented
throughout the course of the intervention. There are general underlying concepts and theories of
rehabilitation interventions. Examples of these theories and concepts include movement and motor
control, human occupation models, education and learning, health promotion and prevention of
additional and secondary health conditions, neural control and central nervous system plasticity,
pain modulation, development and maturation, coping and adjustment, biomechanics, linguistics
and pragmatics, resiliency and self-reliance, auditory processing, and behavior modification.
These concepts, alone or in combination, form the basis for interventions and treatment
plans.
Advances in medical research now support or explain some of the theories or concepts. It
has been demonstrated, for example, that retraining reorganizes neural networks and circuits, that
skill retraining must be task specific and maintaining a skill is use- dependent, that central nervous
system cells and chemical messengers may be replaced, that neural circuits and connections can
be regrown, and that all muscles can be strengthened.
Medical rehabilitation is often considered separately, and is focused on recognition, diagnosis, and
treatment of health conditions (e.g., medication for treatment of fatigue in multiple sclerosis,
botulinum injections for spasticity management in brain injury); on reducing further impairment
(e.g., treatment of ongoing shoulder adhesive capsulitis in stroke, management of osteoarthritis of
the remaining knee in above-knee amputation); and on preventing or treating associated,
secondary, or complicating conditions (e.g., neurogenic bladder management with intermittent
catheterization in spinal cord injury, diagnosis of cervical spinal stenosis in an adult with cerebral
palsy). Although medical rehabilitation does use rehabilitation interventions and espouses the
principles of rehabilitation, medical aspects are additive to rehabilitation interventions and
principles, with common goals of improved function and outcomes.
There is convincing evidence that the rehabilitation process and interventions improve the
functional outcomes of people with a variety of injuries, medical conditions, and disabilities.
Assistive technology is often used in conjunction with rehabilitation interventions; this topic is
covered in the Assistive Technology and Science volume in this series. Rehabilitation interventions
are associated with social participation (e.g., access to education using rehabilitation interventions)
and career planning and employment (e.g., long- term goal of rehabilitation interventions). These
topics are covered in the Education and Employment and Work volumes. There are additional
efforts not covered in this volume that may also be a part of rehabilitation interventions and
processes, which include the discrete areas of mental health and addiction rehabilitation. These are
important areas that have crossover with rehabilitation interventions, have defined sets of
standards and regulation, and have robust histories of development.
Rehabilitation was conceived within the more traditional model of medical care, but it is
increasingly obvious that disability issues are more than medically driven. The social justice and
civil rights model of disability is important to understand, and elements must be
incorporated into rehabilitation interventions, especially as they relate to accessibility of
environments and services. Of all the medical specialties and programs, rehabilitation is the one
most based on quality of life and functioning within the community. Inequalities and differences
must be addressed within the structures of funding and spheres of influence. Increasingly,
insurance plans determine the availability of rehabilitation services, equipment and assistive
devices, and community-based resources; government funding is more limited for education,
especially for those with special needs; and businesses and workers‘ compensation programs are
more restrictive with flexibility and coverage policies.
Components of Rehabilitation Interventions
Rehabilitation is a process designed to optimize function and improve the quality of life of those
with disabilities. Consequently, it is not a simple process. It involves multiple participants, and it
can take on many forms. The following is a description of the individual components that, when
combined, comprise the process and activity of rehabilitation.
Multiple Disciplines
Rehabilitation interventions usually involve multiple disciplines. Although some focused
interventions may be identified by a single service—such as cognitive retraining by a psychologist
or speech pathologist, and audiologic rehabilitation through hearing-aid evaluation and dispensing
—sole service does not engender the rehabilitation concept of a team approach, and it is often
differentiated as therapy or medical service rather than rehabilitation. There are a variety of
professionals who participate in and contribute to the rehabilitation process within a team
approach. The list is long, and it includes (although is not limited to) such professionals as the
following:
Physicians
The physician‘s role is to manage the medical and health conditions of the patient/consumer
within the rehabilitation process, providing diagnosis, treatment, or management of disability-
specific issues. Often, the physician leads the rehabilitation team, although other team members
can assume the leadership role depending on the targeted goal or predominant intervention.
Because of the depth and breadth of their knowledge and training, certified rehabilitation
physicians or physiatrists usually are the best qualified to anticipate outcomes from rehabilitation
interventions and the process of rehabilitation. They also can provide the diagnosis and treatment
of additional medical conditions related to the specific disability or underlying pathology, which
will have an influence on performance and outcome.
Occupational Therapists
Occupational therapists (OTs) typically work with patients/consumers through functional
activities in order to increase their ability to participate in activities of daily living (ADLs) and
instrumental activities of daily living (IADLs), in school and work environments, using a variety
of techniques. Typical techniques include functional training, exercise, splinting, cognitive
strategies, vision activities, computer programs and activities, recommendation of specially
designed or commercially available adaptive equipment, and home/education/work site
assessments and recommendations.
Physical Therapists
Physical therapists (PTs) assess movement dysfunction and use treatment interventions such as
exercise, functional training, manual therapy techniques, gait and balance training, assistive and
adaptive devices and equipment, and physical agents, including electrotherapy, massage, and
manual traction. The outcome focus of interventions is improved mobility, decreased pain, and
reduced physical disability.
Speech and Language Therapist
Speech and language therapist assess, treat, and help to prevent disorders related to speech,
language, cognition, voice, communication, swallowing, and fluency. Rehabilitation interventions
involve more than the spoken word, including the cognitive aspects of communication and oral-
motor function with swallowing. Assistive technology using augmentative or alternative
communication (AAC) devices (e.g., BIGmack switch-activation devices, DynaVox dynamic
display and digitized voice devices) is another focus area of speech pathologists.
Audiologists
Audiologists identify, assess, manage, and interpret test results related to disorders of hearing,
balance, and other systems related to hearing. Hearing screens and more technologically advanced
testing systems fall under the areas of practice. Audiologic rehabilitation interventions include
developing auditory and central processing skills, evaluating and fitting for a variety of hearing
aids and supports, training for use of hearing prosthetics, including cochlear implants, and
counseling for adjustment to hearing loss or newly acquired hearing.
Although sign language is a technique used to assist with communication for those with hearing
impairments, competency is not required for audiologists.
Rehabilitation Nurses
The rehabilitation nurse usually takes the role of educator and taskmaster throughout
rehabilitation, but these professionals have most prominence within inpatient rehabilitation
programs. They are expert at bladder management, bowel management, and skin care, and they
provide education to patients and families about these important areas and also medications to be
used at home after discharge. Activities developed within the active therapeutic rehabilitation
programs are routinely used and practiced, such as dressing, bathing, feeding, toileting, transfers
to and from wheelchairs, and mobility.
Social Workers
Social workers in health settings may provide case management or coordination for persons with
complex medical conditions and needs; help patients navigate the paths between different levels
of care; refer patients to legal, financial, housing, or employment services; assist patients with
access to entitlement benefits, transportation assistance, or community- based services; identify,
assess, refer, or offer treatment for such problems as depression, anxiety, or substance abuse; or
provide education or support programming for health or related social problems. Social workers
work not only with the individual receiving rehabilitation services, but with family members, to
assist both the individual and family in reaching decisions and making emotional or other
adjustments.
Case Managers
Case management is a relatively new concept that has come about with the survival of
patients/consumers with complex medical problems and disabilities, and with the development of
a more complex health care system. Case managers possess skills and credentials within other
health professions, such as nursing, counseling, or therapies, although they usually have a nursing
background. These professionals collaborate with all service providers and link the needs and
values of the patient/consumer with appropriate services and providers within the continuum of
health care. This process requires communication with the patient/consumer and his or her
family, the service providers, and the insurance companies.
Within the rehabilitation environment, case managers ensure that ongoing care is at an
optimal level and covered by insurance or other payer programs, during and following inpatient
rehabilitation or throughout an outpatient rehabilitation process. Coordination of services
following the inpatient admission can be the most difficult task. A hospital, rehabilitation
program, or insurance company may employ case managers.
Rehabilitation Psychologists
Rehabilitation psychology is a specialized area of psychology that assists the individual (and
family) with any injury, illness, or disability that may be chronic, traumatic, and/or congenital in
achieving optimal physical, psychological, and interpersonal functioning (Scherer et al.,2004).
This profession is an integral part of rehabilitation, and it involves assessment and intervention
that is tailored to the person‘s level of impairment and is set within an interdisciplinary
framework.
Neuropsychologists
Neuropsychology is another specialized area within psychology, and it is of particular importance
in the care of individuals who have sustained brain injuries. These professionals possess
specialized skills in testing procedures and methods that assess various aspects of cognition (e.g.,
memory, attention, language), emotions, behaviors, personality, effort, motivation, and symptom
validity. With this testing, the neuropsychologist can determine whether the level and pattern of
performance is consistent with the clinical history, behavioral observations, and known or
suspected neuropathology, and the degree to which the test performance deviates from expected
norms. Additional contexts encountered in brain injury survivors can complicate the clinical
presentation and impact neuropsychological test performance. The neuropsychologist can identify
emotional states arising from changing life circumstances (e.g., depression, anxiety), medical co-
morbidities (e.g., substance abuse, heart disease), and social-contextual factors (e.g., litigation,
financial distress), and can then explain their potential influence to the injured person, family
members, and other health care providers.
Therapeutic Recreation Specialists
Recreational therapists, also referred to as therapeutic recreation specialists, provide treatment
services and recreation activities for individuals with disabilities or illnesses. They use a variety of
techniques to improve and maintain the physical, mental, and emotional well- being of their
clients, with the typical broad goals of greater independence and integration into the community.
Therapists promote community-based leisure activities as a complement to other therapeutic
interventions, and as a means to practice those clinic- or hospital-based activities within a real-
world context.
Rehabilitation Counselors
Rehabilitation counselors (previously known as vocational counselors) assist persons with both
physical and mental disabilities, and cover the vocational, psychological, social, and
medical aspects of disability, through a partnership with the individuals served. Rehabilitation
counselors can evaluate and coordinate the services needed, provide counseling to assist people in
coping with limitations caused by the disability, assist with exploration of future life activities and
return-to-work plans, and provide advocacy for needs. Orthotists and Prosthetists
These professionals practice within a unique area of rehabilitation, combining technical and some
clinical skills. The orthotist fabricates and designs custom braces or orthotics to improve the
function of those with neuromuscular or musculoskeletal impairments, or to stabilize an injury or
impairment through the healing process. The prosthetist works with individuals with partial or
total limb absence or amputation to enhance their function by use of a prosthesis (i.e., artificial
limb, prosthetic device). The orthotist/prosthetist usually works with a physician, therapist, or
other member of the rehabilitation team to ensure an effective design to meet the needs of the
individual, especially regarding the ability to maneuver within the built environment and be
socially active.
Additional Rehabilitation Professionals
Other rehabilitation professionals who might be considered members of the team include
nutritionist, spiritual care, rehabilitation engineer, music therapist, dance therapist, child-life
specialist, hospital-based school teacher, massage therapist, kinesiologist, and trainer, among
others.
Person with the Disability and His or Her Family
The person with the disability and his or her family members are partners in this team
process. In fact, they are key members of the team. Personal and family/support system
goals, family/friend support, and community resources are driving forces regarding goals and
discharge planning within the rehabilitation process. The process involves the best strategies of
interventions based on standards of care, the evidence base regarding outcomes related to
interventions, the experience of the practitioners, and the personal and family needs and
contexts of the person with the disability. Professionals should be skillful in their
communication to consumers about anticipated outcomes and effectiveness of interventions.
Community-Based Rehabilitation
CBR was originally designed for developing countries where disability estimates were very high
and the countries were under severe economic constraints. It promotes collaboration among
community leaders, peoples with disabilities and their families and other concerned
citizens to provide equal opportunities for all peoples with disabilities in the community and to
strengthen the role of their organization.
According to the view of World Health Organization (WHO) and United Nations
Education, Scientific and Cultural Organization (UNESCO), CBR is a strategy that can address
the need of peoples with disabilities within their community which can be implemented through
the combined efforts of peoples with disabilities themselves, their families, organizations and
communities, governmental and non-governmental organizations, health, education, vocational,
social and other services. Community based rehabilitation is a combination of two important
words; community and rehabilitation. Thus in order to get clear concept about the definition of
CBR, let us first define the two terms separately.
Community-consists of people living together in some form of social organization sharing
political, economic, social and cultural characteristics in varying degrees.
Rehabilitation-includes all measures aimed at reducing the impact of disability for an individual
enabling him or her to achieve independence, social integration, a better quality of life and self
actualization or refers to measures which aim to enable persons with disabilities to attain and
maintain maximum independence, full physical, mental, social and vocational ability, and full
inclusion and participation in all aspects of life.
If you give a person a fish,
He/she will eat for a day;
If you teach him/her to fish,
He/she eat for a lifetime.‖
Based on the above definition of key words, CBR is therefore, a systematized approach within
general community development whereby Persons with Disabilities are enabled to live a fulfilling
life within their own community, making maximum use of local resources and helping the
community become aware of its responsibility in ensuring the inclusion and equal participation of
―Persons with Disabilities‖ (PWDs). In the process, PWDs are also made aware of their
own role and responsibility, as they are part of the community.
The idea of CBR is that people with disabilities should have the right to a good life. The
help they need should be available to them, at a low cost. It should be offered to them and their
family in a way that suits their usual way of living, whether in a village, a town or a
city. They should have education like everybody else. They should be able to take up jobs and
earn their living. They should be able to take a full part in all the activities of their village, or
town or city.
The idea of CBR is that, even if people learn very slowly, or has problems seeing or
hearing, or finds it hard to move about, they should still be respected for being men and women,
girls and boys. Nobody should be looked down on or treated badly just because they have a
disability. Houses, shops and schools should be built in such a way that everyone can easily go in
and out and make use of them. Information should be given to people in a way they understand,
not only in writing, which is hard for people who cannot read or see it. Information should be
given in spoken forms as well, so that everyone has a fair chance to use it. To do all this would
mean a lot of changes. But they would be good changes, because everyone could live a better life,
helping each other and respecting one another. In addition, for the purpose of our discussion two
important definitions will be given:
1. Community based rehabilitation is a strategy that can address the needs of peoples with
disabilities with in their communities (WHO, UNESCO, 2004).
2. Community based rehabilitation is a common sense strategy for enhancing the quality of life of
peoples with disabilities by improving services delivery in order to reach all in need by providing
more equitable opportunities and by promoting and protecting their rights .
3. The joint position paper by WHO, ILO, UNICEF and UNESCO of the 2004 define CBR in a
rather flexible and broad manner in the following way: Community based rehabilitation is a
strategy within general community development for rehabilitation, equalization of opportunities
and social inclusion of all children and adults with disabilities. It is implemented through the
combined efforts of people with disabilities themselves, their families and communities, and the
appropriate health, education, vocational and social services.
This definition particularly advocates a broad approach for developing programs that involves
the following elements:
A. The participation of people with disabilities and their representatives at all stages of the
development of the program
B. The formulation and implementation of national policies to support the equal participation of
people with disabilities
C. The establishment of a system for program management
D. The multi-sectoral collaboration of governmental and nongovernmental sectors to support
communities as they assume responsibility for the inclusion of their members who experience
disabilities.
E. CBR focuses on strengthening the capacity of peoples with disabilities, and their families.
F. CBR focuses on challenging negative views and barriers in society to enable equal rights and
opportunities.
Currently, three main meanings are attached to the notion of CBR: People taking care of
themselves, a concept and an ideology and community based rehabilitation wich will be
described below.
1. People Taking Care of Themselves
Services for people with disabilities in most regions in developing countries are still limited to
what people can do for themselves. This is the "real" CBR: all the activities that people with
disability, their family members and other community members do in their own community for
persons with disability, such as general care, accommodating each other's needs {i.e.. family
members adapting themselves to the situation of the individual with disability, and vice-versa),
education and health, using whatever they know, whatever they have, in whatever daily
circumstances they exist.
2. A Concept and an Ideology. As a concept and an ideology, it promotes a decentralized
approach to rehabilitation service-delivery, whereby, it is assumed that community members
are willing and able to mobilize local resources and to provide appropriate services to people
with disabilities. This concept has been 'fled out in many CBR programs in the developing
world, by the use of government staff and facilities, but has in most cases proved to be
unrealistic.
3. Community Based Rehabilitation: is mostly in a form of Non-Governmental
Organizations (NGOs). Recognizing the human and material limitations of people with
disabilities, their family members and other community members, CBR program tries to
promote and facilitate community based rehabilitation. Unfortunately, such CBR programs
often consider 'local culture' as an obstacle, rather than as a condition towards progress.
Major Objectives of Community Based Rehabilitation
The major objective of community based rehabilitation is to ensure that people with
disabilities are empowered to maximize their physical and mental abilities, have access to
regular services and opportunities and become active, contributing members of their
communities and then societies. Thus, community based rehabilitation promotes the human
rights of people with disabilities through attitude changes within the community. Community
based rehabilitation aims to include people who have disabilities from all types of
impairments, including difficulty hearing, speaking, moving, learning or behaving.
Community based rehabilitation also includes all age groups: children, youth, adults and
older people.
Implement Technologies for Disability Inclusion
Inclusiveness and Information Technology (ICT)
Inclusiveness and Information Technology examines the extent to which regulatory frameworks
for information and communication technologies (ICTs) safeguard the rights of persons with
disabilities and vulnerabilities as citizenship rights. Effective access to information is crucial in
facilitating the participation of citizens in civil society. Accessibility concerns in the information
and communications technologies (ICTs) sector have become particularly important, given the
increased role played by ICTs in everyday life. For persons with disabilities and vulnerabilities,
technological developments such as the proliferation of the Internet and the provision of services
for accessing digital television such as audio description (video description), closed signing, and
the availability of subtitles (captions) in live broadcasts enabled by speech-to text technologies can
make an important contribution to facilitating independent living. Unfortunately, persons with
disabilities and vulnerabilities still face significant barriers in accessing ICTs. These barriers
include, inter alia, poorly designed Web sites (e.g., with graphics not readable by computerized
screen readers, with information that can be accessed only by the use of the mouse rather than the
keyboard), limited availability of subtitles on webcasts, the use of multiple remote controls for
digital television, and difficult to navigate on-screen displays.
These access barriers have the potential to affect persons with disabilities, including
persons with sensory disabilities (visual and/ or hearing), mobility disabilities, or cognitive
disabilities. The objective to ensure equal access to information should play a central role in any
regulatory framework for the ICT sector. Nevertheless, despite the potential of technology to
empower the public as citizens, the regulatory framework for the ICT sector
has been criticized for its overall perception of the public as economic actors and for the
insufficient level of protection conferred to citizenship values such as equality and dignity.
Inclusiveness and Assistive Technology
Worldwide the number of persons with disabilities, vulnerabilities and marginalized groups is
increasing alarmingly because of population aging, accident, global warming and climate change,
medical advancement, humanitarian crises, natural disaster, conflict and increases in chronic
health conditions, among other causes. Over a billion people, about 15% of the world's
population, have some form of disability. Between 110 million and 190 million adults have
significant difficulties in functioning. Technologies promote independence for people with
disabilities and vulnerability. The use of devices, computers, robots, and other established
assistive technology (AT) can potentially increase the autonomy of people with disabilities and
vulnerability, by compensating for physical limitations and circumventing difficulties with
normal activities of daily living (ADL).
Vulnerability and disability have adverse impact on quality life of these groups.
Vulnerable people and those living with disabilities are losing their independence and overall
wellbeing. The growing number of persons with disabilities and vulnerabilities is too large to be
cared for through traditional government programs. The cost associated with such programs and
the lack of a skilled caregiver workforce makes it very difficult to meet the needs of this segment
of the population. It is therefore inevitable that we resort to technology in our search for solutions
to the costly and challenging problems facing persons with disabilities and vulnerabilities.
Wellbeing or quality of life is an important concern for persons with disabilities,
vulnerabilities and marginalized groups, who, like every person, is seeking to be well, happy,
healthy, and prosperous. Persons with disabilities, vulnerabilities and marginalized groups have
several important components of wellbeing. A key activity is independent living with convenient
access to goods and services, as well as being socially active and enjoying self- esteem and
dignity. In modern societies, persons with disabilities, vulnerabilities and marginalized groups can
attain some components of wellbeing such as access to services using assistive technology (AT).
Other components, such as freedom of navigation and travel, are much more difficult because of
environmental obstacles encountered by the disabled.
Assistive Technologies (AT)
Surgery, generic therapy, rehabilitation, human assistance, and the use of assistive technology
(AT) help disabled people cope with their disabilities. Surgery (medical intervention) helps
decrease deficiency and, in some cases, restores capability. Genetic therapy attempts to remediate
genes responsible for a given disease or disorder. Although promising in concept, genetic therapy
is in its infancy and, as yet, has no broad application. Rehabilitation develops and adapts residual
capabilities, while human assistance aids Persons with disabilities and vulnerabilities in their
daily living activities. Unfortunately, such assistance is not always available and not necessarily
cost-effective. AT can increase the autonomy, independence, and quality of life for Persons with
disabilities and vulnerabilities and can also enable the integration of social, professional, and
environmental aspects of life for Persons with disabilities and vulnerabilities populations.
AT and Daily Living of Persons with disabilities and Vulnerabilities
Assistive technology affords Persons with disabilities and vulnerabilities greater equality of
opportunity, by enhancing and expanding their communication, learning, participation, and
achievement with higher levels of independence, wellbeing, and quality of life. Such assistive
technologies are essential for helping Persons with disabilities and vulnerabilities with severe
physical, sensorial, or mental limitations to become more independent, and to improve their
quality of life. Typically, AT works by compensating for absent or nonfunctional skills, by
maintaining or enhancing existing abilities. Persons with disabilities and vulnerabilities utilize AT
to enhance the performance of their daily living tasks, including communication, vision, hearing,
recreation, movement, seating and mobility, reading, learning, writing, and studying, as well as
controlling and accessing their environment.
Assistive Technology varies from low-tech devices such as a cane or adapted loop, to
high-tech systems such as assistive robotics or smart spaces. Currently, most popular technologies
for Persons with disabilities and Vulnerabilities are simple; or examples of mobility-enhancing
equipment include wheelchairs, communication via mobile telephones and computers, and voice-
activated smart devices to enhance environmental control.
Advances in communication and information technologies further support the
development of new, more complex technologies such as utilization of smart wheelchairs,
assistive robots, and smart spaces.
AT Definitions
Assistive technology encompasses all systems that are designed for Persons with disabilities and
Vulnerabilities, and that attempt to compensate the handicapped. This includes robotic tele
manipulators, wheelchairs, or navigation systems for the blind. AT also includes systems that
restore personal functionality, such as external prostheses and ortheses. There are various
organizational definitions for assistive technology: The international standard ISO 9999 defines
AT (referring to AT as ―technical aid‖) as ―any product, instrument, equipment or
technical system used by a disabled person, especially produced or generally available,
preventing, compensating, monitoring, relieving or neutralizing the impairment, disability or
handicap‖ . In the United States, the Technology Act and Assistive Technology Act define an AT
device as ―any item, piece of equipment or product system, whether acquired
commercially, modified, or customized, that is used to increase, maintain, or improve functional
capabilities of individuals with disabilities.‖ These Acts also define an assistive technology service
as ―any service that directly assists an individual with a disability in the selection, acquisition,
or use, of an assistive technology device.‖
The Older Americans Act defines AT as ―technology, engineering methodologies, or
scientific principles appropriate to meet the needs of, and address the barriers confronted by, older
individuals with functional limitations.‖
In Europe, the European Commission (EC) defines AT as ―products, devices or
equipment that is used to maintain, increase or improve the functional capabilities of people with
disabilities‖. The World Health Organization (WHO) defines an Assistive Device as
―Equipment that enables an individual who requires assistance to perform the daily activities
essential to maintain health and autonomy and to live as full a life as possible. Such equipment
may include, for example, motorized scooters, walkers, walking sticks, grab rails and tilt-and-lift
chairs‖ WHO also defines assistive technology as ―An umbrella term for any device or system
that allows individuals to perform tasks they would otherwise be unable to do or increases the ease
and safety with which tasks can be performed‖.
AT and User Needs: A Classification Scheme
Examples of AT user needs and classification
A. People with Communication Disabilities refers to be multiple difficulties including: Speech
mechanism problem, Language processing, Hearing, Vision, Motor skills
Needs & Barriers: Safety Technologies, Self-care and medication management, social needs
socialization, access to information technology, communication and interaction with environment, access
to public administration and facilities (authorities, banks, public services), shopping recreation and leisure
problems with speech, writing, esteem independence and employment.
Assistive technologies: Mobile systems [phones, wearable electronics, computers, augmentative and
alliterative communication (including I/O interfaces) (adaptable/configurable interfaces, tactile interfaces),
vibrotactile displays reading screen, speech technologies, augmentative–alliterative communication.
Socialization and entertainment tools (special games, virtual companion‘s videoconferences). Medication
organizers (medication reminder/management). Speech technology (audio technology for I/O interfaces
and control, writing translators, text–speech translators, transportation (public transportation facilities,
smart environments home control, pervasive computing, context awareness, middleware) Shopping tools
(Internet access) and education tools
B. People with Cognitive Disabilities: The impairments may include: Cognition, memory loss and
forgetfulness
Needs & Barriers are survival, hygiene (toileting, bathing, laundry); feeding (food preparation,
eating, drinking), remembering, housekeeping—home cleaning, safety, safety technologies, safety
of environment, self-care and medication management, social needs, socialization, navigation,
access to information technology, education, communication and interaction with environment,
shopping, esteem, independence, employment, recreation and leisure
Assistive technologies may include Mobile systems (phones, wearable electronics, and
computers), socialization and entertainment tools (special games, virtual companions,
videoconferences), augmentative and alliterative communication (including I/O interfaces),
adaptable/configurable interfaces, organizer and reminder assistants for timekeeping),
medications, (appointments, hygiene, etc., electronic organizers, medication
reminder/management, procedure assistants, transportation public transportation facilities)
Communication aids (communicators, multimedia procedure, assistants, large-screen
programmable phones, electronic information organizers, electronic mail)
C. People with Motor Disabilities impairment include Upper-limbs difficulties/ dexterity, lower- limb
deficiencies
Needs & Barriers are the need for mobility, working in the inaccessible environment Assistive
technologies may include orthotics (cognitive orthotics), smart environments, home control,
shopping tools (internet access) and education tools
AT and the Marketplace
Markets for assistive technologies follow the general marketing rule that products introduced into
a market influence the demand and growth of markets for such products. In practice, AT products
can either represent a barrier to demand or become an engine of demand. This relationship
between Persons with disabilities and Vulnerabilities and AT in the marketplace follows one of
two strategies: (1) trivialization or (2) specialization, which are discussed as follows:
Specialization is based on the development of products or services that are adapted for
Persons with disabilities. In practice, the AT industry considers Persons with disability
populations as solvent autonomous markets. Developed products are adapted for Persons with
disabilities needs, so the satisfaction of each target population or subpopulation is good, thereby
supporting further product development or adaptation. Nonetheless, the market for such AT is not
growing quickly, owing to (1) development costs, (2) high price of the final product, and (3)
generally low income of people with disabilities. The exceptionto this rule is products for elderly
retired people, which have significantly higher incomes and a much larger market.
Trivialization considers Persons with disabilities as an augmentation of the market for
devices used by people without disabilities. In this strategy, industry does not target Persons with
disabilities and Vulnerabilities populations directly. Instead, the products for Persons with
disabilities and Vulnerabilities are of standardized type, that is, generic with multipurpose
capabilities. Given requirements for safety and comfort, these products and services are designed
to be modified or adapted to meet Persons with disabilities and Vulnerabilities needs. This
strategy targets a much larger market but does not consider user satisfaction among Persons with
disabilities and Vulnerabilities.
AT and Design Methods
Given the requirements of functionality, safety, and comfort, the design of AT for Persons with
disabilities and Vulnerabilities requires both excellent engineering capacities and relevant
knowledge about Persons with disabilities and Vulnerabilities characteristics. Product developers
must be fully aware of needs, wants, and capabilities of Persons with disabilities and
Vulnerabilities populations, as well as limitations associated with each handicap. Numerous
design methods have been suggested to assist in the process of AT development. Most widely
known are user centered design and universal design, which are discussed as follows:
User-centered design is a set of techniques and processes that enable developers to focus
on users, within the design process. In practice, users are involved in the development process,
depending on their skills and experience, and their interaction is facilitated by a domain expert.
The intensity of this involvement varies with the stage of research and product development.
Often, the developed AT meets persons with disabilities satisfaction. However, this design method
is expensive in terms of resources and time expended by engineers and domain experts. It is also
difficult to recruit potential end users and to interact with them, especially when these end users
are older people, or people with disabilities (see also Chapter 34).
Universal design (also called design for all) is the design of products and environments to
be usable by all people, to the greatest extent possible, without the need for adaptation or
specialized design. Here, the design process is guided and constrained by a number of objectives:
accessibility, adaptability, trans generational applicability, and/or universal applicability or appeal.
Universal design does not emphasize differences among persons with disabilities, or between
persons with disabilities and the general population.
Instead, the ideas of adapting products, services, or the environment are extended to users at large.
In practice, products are developed to meet the needs of average users. If a user is different,
significantly, from the average population, (e.g., a person with a significant handicap), then, the
product will provide poor user satisfaction.
Universal Design
It is frequently the case that the built environment can be modified permanently so that functional
limitations become less disabling and personal or temporary assistive technologies are not needed.
For example, the presence of ramps increases the ability of wheelchair users to get around and
thus decreases the degree to which the condition that led to their use of a wheelchair is disabling.
The presence of ramps will increase frequency of trips out of the house and into the community
for wheelchair users when ramps are installed in their houses. Wider doors, lower bathroom sinks,
and grab bars are other examples of modifications to build environments that decrease the degree
to which a building itself may be disabling. Lighting patterns and the materials used for walls and
ceilings affect the visual ability of all people, even though the largest impact may be on improving
the ability of the person who is hard of hearing to hear in a particular room or the ability of a
person who is deaf to see an interpreter or other signers.
Universal design is based on the principle that the built environments and instruments used
for everyday living can be ergonomically designed so that everyone can use them. Traditionally,
architecture and everyday products have been designed for market appeal, with a greater focus on
fashion rather than function. However, as the population of older adults and people with
disabling conditions increases, there has been a greater trend toward universal design.
Today, with the influence of consumer demand and through thoughtful disability policy,
greater emphasis is placed on the development of built materials that are ergonomically friendly to
users, regardless of their abilities. Universal design is an enabling factor in the environment that
allows the user with a functional limitation to become more independent, yet without an additional
cost or stigma attached to the particular product. For example, people who were deaf previously
had to purchase an expensive closed-captioning unit to attach to their television sets to view
closed-captioned programs. Today, as a result of new federal legislation, all new television sets are
manufactured with a closed-captioning microchip that allows any user access to broadcast closed
captioning. Thus, it is useful not only for deaf users but also for other vulnerable groups, such as
older individuals who are starting to lose their audio acuity, or a person watching a late-night talk
show in the bedroom who does not want to wake his or her partner.
In all of these ways, the environment affects the degree to which a functional limitation is
disabling for a person. However, decisions about the use of technology or built environments are
social decisions. The next major section considers the effects of the social and psychological
environments on the extent to which a particular functional limitation will be disabling or not.
Implement Inclusive Job Opportunities and Employment
The right to work is fundamental to being a full and equal member of society, and it applies to
all persons, regardless of whether or not they have a disability. A decent job in the open labor
market is a key bulwark against poverty. It also enables people to build self-esteem, form social
relationships, and to gain skills and knowledge. Moreover, a productive workforce is essential for
overall economic growth. Barriers to employment thus not only affect individuals‘ lives, but the
entire economy. Despite the fact that the majority of jobs can be performed by individuals with
disabilities, the pathways to their employment are often
strewn with barriers. An OECD study of its members showed that persons without disabilities
were nearly three times more likely than persons with disabilities to participate in the labor
market.2 Evidence suggests the same is true for countries in the Asia and Pacific region, although
data to illustrate the full extent of this trend is scarce. The employment gaps suggested above are
likely to understate the divergent work experiences of persons with and without disabilities, since
they do not factor in differences in type of employment. Persons with disabilities and
vulnerabilities are more likely to be own-account workers and occupy jobs in the informal sector,
often without the security offered by work contracts, salaries, pension schemes, health insurance
and other benefits. Even when persons with disabilities are formally employed, they are more
likely to be in low-paid, low-level positions with poor prospects for career development. Simple
comparisons of the employment rates for persons with and without disabilities can therefore be
misleading.
The recently adopted 2030 Agenda for Sustainable Development calls on governments
around the world to promote full employment and decent work for all, including persons with
disabilities and vulnerabilities. Besides directly targeting employment, the 2030 Agenda and the
accompanying SDGs also emphasize the need to guarantee the rights of persons with disabilities
and vulnerabilities to equal and accessible education; social, economic and political inclusion, and
access to cities, transport systems and public space.
Barriers of employment
Barriers to the employment of persons with disabilities take many forms and operate at
many levels, both within and beyond the workplace itself. Persons with disabilities may be
prevented from working due to inaccessible transportation services; the lack of accessible
information and communications services; the preference of employers for candidates without
disabilities; legal stipulations that prevent individuals with particular impairments from working in
certain fields; or the discouragement of family and community members. Whilst these obstacles
are often interconnected, and act collectively to limit employment opportunities for persons with
disabilities, it is essential to distinguish between different barriers in order to develop effective
policy responses. The major types of barriers are described below.
A) Attitudes and Discrimination
Employers may be reluctant to hire persons with disabilities based on the perception that they are
less productive or less capable of carrying out their jobs than others. Colleagues of persons with
disabilities may also hold prejudicial attitudes. At a wider level, social attitudes that cast persons
with disabilities as objects of pity and need perpetuate the assumption that they should not work.
In some cultures, people view disabilities as being indicative of wrongdoing in a past life, or are
simply uncomfortable around people who seem different. Persons with disabilities may also be
discouraged from working by their families, often out of a sense of shame or a well-intentioned
but stifling desire not to impose additional burden on their family members.
Though there are laws and regulations in some sectors, majority of social and economic
sectors in Ethiopian do not yet have anti-discrimination legislation that specifically targets the
employment of persons with disabilities. Discrimination is a major barrier faced by persons with
disabilities in their efforts to find employment in the labour market. Clearly, there needs to be
greater awareness about the need to break down barriers faced by persons with disabilities — be it
lack of accessibility features in public services or of laws that protect persons with disabilities
from discrimination by employers.
B) Accessibility
The accessibility of the following areas are crucial to the employment of persons with disabilities:
the physical environment; transportation; information and communications; and other facilities
open to the public. In the workplace itself, a lack of physical features such as ramps and elevators
can prevent persons with mobility disabilities from being able to work. Similarly, the lack of
accessible information and communication infrastructure in workplaces such as clear signage,
computers equipped with software such as screen-readers, and devices such as Braille displays can
prevent persons with print and intellectual disabilities from being able to gain employment. Lack
of access to sign language interpretation or captioning services can inhibit the employment of deaf
people. In addition to the informational and physical design of the workplace itself, the broader
inaccessibility of public environments and crucially, transport, can prevent persons with
disabilities from being able to travel to work, receive information about job opportunities, and
communicate with employers.
C) Education and Training
Persons with disabilities have disproportionately restricted access to education and training. This
severely limits their job opportunities due to a lack of skills and knowledge that are
relevant to find or retain a job. Children with disabilities are less likely to attend school, and when
they do they are less likely to stay in school.18 In Indonesia, children with disabilities are one
third less likely to complete their primary education as those without a disability. In India in 2007,
close to 40 per cent of children with disabilities were not enrolled in school, compared to only
between 8 and 10 per cent of children in scheduled tribes or castes — groups that also face high
levels of discrimination and poorer socio-economic outcomes. Notwithstanding the numerous
other barriers they face, persons with disabilities are thus often prevented from being able to
acquire the human capital necessary to effectively compete for jobs. In addition, young persons
with disabilities who have attended school may not get the support they need when transitioning
from school to work.
D) Social Networks
Another barrier to employment for persons with disabilities can be their more limited social
networks. Social networks greatly aid the process of searching for work, the lack of which is likely
to limit options for persons with disabilities. As part of their broader exclusion from many
important social activities, persons with disabilities often therefore lack the opportunity to build
social relationships with those who may be in a position to offer suggestions for potential work
opportunities. These limited networks are part of the broader cultural and attitudinal barriers that
inhibit participation in social, leisure, civic, and religious activities. A key benefit brought by
employment itself is the building of social relationships with colleagues, clients and business
partners. As a result of the barriers they face in entering and retaining work, many persons with
disabilities are also denied the possibility of expanding their networks at the workplace itself.
E) Women Disabilities
In many developing countries including Ethiopia, as a result of continued prejudices both towards
women and surrounding disability, women with disabilities are doubly discriminated against in the
labor market. Study found that in many developing countries, women with disabilities are only
half as likely as men with disabilities to have a job. Moreover, when they are employed, women
with disabilities encounter worse working conditions and lower pay as compared with other
women, as well as men with disabilities. Women with disabilities are also less likely to receive
education and vocational training, and those women who do access education and attain a degree
of financial stability are more likely to have done so before acquiring their disability. However, it
remains difficult to quantify these trends as a result of the limited availability of reliable data that
is disaggregated by both sex and disability. Not
only the particular difficulties faced by women with disabilities as they search for work, but also
the significance of social networks in sharing potential employment opportunities. The
governments and NGOs must ultimately step up to improve the precarious economic situation
many women with disabilities find themselves in.
F) Legal Barriers
As a result of discriminatory attitudes about the perceived capabilities of persons with disabilities,
some countries impose legal restrictions on their participation in certain types of employment or
processes. In some countries, people must be considered ‗physically and mentally healthy‘ or
‗sound‘ to represent oneself in a court of law, to occupy official positions, or to use certain public
services.25 Such laws effectively rule out large numbers of persons with disabilities from
accessing employment, based on the blanket assumption that they are incapable of doing particular
jobs effectively. Japan is one country that previously had such laws, but has taken action to rectify
them.
G) Inflexible Work Arrangements
Another common obstacle to the employment of persons with disabilities is the inflexibility of
work arrangements. In some cases, persons with disabilities might prove to be competent and
productive employees, but are nonetheless unable to perform certain tasks. The same is true for
scheduling the work day. Persons with disabilities may have particular transportation issues or
other needs that require a slightly different work day. An employer‘s willingness to rearrange the
responsibilities and schedules associated with a particular job can mean the difference between
employment and unemployment for many persons with disabilities. Indeed, a greater degree of
flexibility of working arrangements can boost the morale and productivity of any employee,
regardless of whether or not they have a disability.
H)Dismissal on the Basis of Disability
Workers who are injured and acquire a disability on the job may face unaccommodating policies
and a lack of rehabilitative services, which limit their ability to return to work. The absence of
anti-discrimination legislation in the majority of countries in the region thus allows employers to
dismiss staff on the basis of disability with impunity. Several countries, such as Iran, offer
rehabilitation programs and services to help dismissed workers to find new employment.
Ultimately though, legislation which protects the rights of workers from dismissal on the basis of
disability is also needed to more comprehensively tackle the problem
I) The Benefit Trap
Another obstacle to the employment of persons with disabilities can ironically be imposed by
social protection schemes ultimately designed to support them. These schemes can encourage
individuals to stay out of the labor force if they are structured in such a way as to make the receipt
of benefits contingent on the inability to work. Therefore, even if persons with disabilities believe
that they can work, they may choose not to in order to continue receiving disability benefits. Even
if working could offer them a higher level of income, persons with disabilities may still choose
to receive benefits because of the risk of attempting to hold down a job that does not provide
adequate support, or is not flexible towards their needs. It is important to stress that this ‗benefit
trap‘ is mainly relevant to more developed countries with more generous benefit schemes. The
situation in most of the region‘s middle-to-low income countries is entirely different. However, it
is vital for governments to avoid creating strong work disincentives.
Strategies to Improve Employment for Persons with Disabilities and Vulnerabilities
There a number of strategies that is available to governments in respective sector as they work
to improve the employment prospects of persons with disabilities, vulnerable and
marginalized groups. In addition, private sector initiatives that have been demonstrated to
improve the employment experiences of persons with in these groups are also discussed
below.
A) Anti-Discrimination Legislation
These laws make it illegal to discriminate against an individual on the basis of disability in a range
of areas including: employment; education; access to public buildings; the provision of goods and
services, and political processes. With regard to employment, anti-discrimination laws protect
persons with disabilities from discriminatory actions in hiring and termination of contracts and
affirm the right of persons with disabilities to access employment on an equal basis with others.
Anti-discrimination laws challenge collectively held discriminatory attitudes against persons with
disabilities by influencing ‗the nexus between law, norms and social mores‘.26 Anti-
discrimination laws can be made stronger when they include mandates for reasonable
accommodations that remove additional barriers to employment for persons with disabilities.
Crucially, however, these laws must outline clear enforcement mechanisms.
When penalties are neither stipulated nor enforced, employers are left free to discriminate with
impunity.
B) Vocational Education And Training
Technical vocational education and training (TVET) programs can help to ensure that the
workforce has the skills and knowledge necessary to obtain and retain a job, while also driving
productivity and economic growth.27 As discussed in Chapter 2, persons with disabilities often
have limited opportunities to build skills and knowledge that are relevant to the labor market. A
vital first step in improving access to employment for persons with disabilities is therefore to
ensure that employment support and vocational programs are as inclusive as possible. Such
programs should also be held in accessible locations, and reasonable accommodations should be
made to improve the access of persons with disabilities. Some persons with disabilities may not be
able to attend mainstream training programs. In such situations, to allow them to participate,
programs targeted at persons with disabilities may be required. It is crucial; however, that the
content of such training programs is geared to labor market demands, and not determined by prior
beliefs about what persons with disabilities should do or are capable of doing.
C) Wage Subsidies
Wage subsidies cover a portion of employees‘ wages, usually for a limited period of time, as a
way to lessen the risk perceived by employers of hiring persons with disabilities. Since wage
subsidies directly target the recruitment process of private firms, they enable employers to
overcome their reservations about hiring employees with disabilities. It is vital that care is taken in
determining the eligibility, amount and duration of subsidies, to avoid the subsidies exceeding the
actual gap in productivity between persons with and without disabilities. Studies on the impact of
subsides show mixed results on employment rates. Most studies suggest, however, that both
workers and employers are satisfied with wage subsidy schemes.
D) Supported Employment
These programs integrate persons with disabilities into the open labor market by providing direct,
on-the-job support to employees with disabilities. Supports are usually offered for a limited period
of time. One common type of support is a job coach. Job coaches provide on- site, individually
tailored assistance to help persons with disabilities perform their jobs. Coaches also help persons
with disabilities adjust to their working environment, and assist in determining which accessibility
accommodations are necessary. Supported employment has been shown to be particularly cost-
effective for people with intellectual and psychosocial
disabilities, in terms of productivity and health related costs. Supported employment requires
employers to be open to having such services on site, and to be willing to work cooperatively with
job coaches and other service providers. Employment support services and job coaches require
special training.
E) Workplace Accommodation Schemes
These schemes reduce the costs to employers of making workplaces more accessible to
persons with disabilities. In so doing, workplace accommodation schemes seek to minimize
employer reluctance to hire persons with disabilities. There are two ways Government programs
can decrease or even eliminate those costs. The first is by offering tax breaks or tax credits for
expenditures undertaken to make such adjustments. This strategy may, however, be less effective
for small businesses with cash flow issues or limited tax liability. Another strategy is to provide
full or partial funds for reasonable accommodations for employees with disabilities. Such
funding can be provided in various ways, either through employment agencies, using fines from
quota systems, or by offering grants to employers from separate Government agencies.
Investment in assistive equipment for employees returned costs by about eight times through
increased productivity and reduced absenteeism.
F) Workers’ Compensation
These programs are designed to address the issue of occupational injuries and illnesses. They
provide cash and medical benefits to employees whose disability is acquired in the workplace.
Generally, workers‘ compensation operates through insurance programs - either through public
insurance programs, or private or even self-insurance at large firms. Because employer premiums
are experience rated, they are higher for firms with more accidents. Thus, the approach
incentivizes workplace safety and encourages employers to support employees who acquire
disabilities at work to be able to return to their jobs. In many countries, employers are legally
mandated to establish workers‘ compensation programs.
G) Quota Systems
Quota systems mandate that firms hire at minimum a certain percentage of persons with
disabilities. Typically, quotas apply only to large employers. Empirical data points to only small
net employment gains of persons with disabilities. In addition, quotas can prove difficult to both
monitor and enforce. Moreover, by obliging employers to hire a specific number of persons with
disabilities, quota systems perpetuate the prejudice that persons with disabilities are not really
equivalent to others in their capacity to be productive.
H) Sheltered Workshops
These programs only hire persons with disabilities, and structure jobs around the perceived
abilities of each employee. Sometimes the stated goal of sheltered workshops is to serve as a
training ground for the eventual transition of employees to the open labor market. In reality,
however, employees with disabilities are rarely supported to make this transition. Employees are
generally paid poorly, and the workshops in which they work are seen as charitable enterprises
and are funded as such, with revenues being a function not of sales but of the number of
employees. Rather than promoting sheltered workshops, governments can serve their citizens with
disabilities better by removing barriers towards their employment in the open labor market.
Persons with severe disabilities may find it difficult to enter the open labor market, even if
other barriers to their employment are removed. In certain cases therefore, programs that create
non-competitive job opportunities may be necessary. Government and public agencies should be
mandated by law to preferentially procure certain products from such workshops in order to
guarantee a stable income for their employees with severe disabilities.
I) Private Sector Initiatives
In addition to government-driven strategies, a number of private-sector initiatives also serve to
illustrate the need for action to be taken not only by governments, but by employers themselves.
J) Employer Networks
A number of networks of private companies around the world have initiated their own programs
to promote the employment of persons with disabilities. Sometimes these organizations are
established in response to the creation of a quota policy, sometimes out of a sense of corporate
social responsibility, and sometimes because of a compelling business case for being more
inclusive.
The main activities of employer organizations include:
 Raising awareness and building capacity on disability inclusion;
 Providing information and tools on disability and employment;
 Influencing policy on the employment and training of persons with disabilities;
 Providing career development opportunities and organizing vocational
training;
 Linking jobseekers with disabilities and employers;
K) Support Disability-Inclusive Business
Private employers can play an important role in developing policies and programs to boost
employment for persons with disabilities, as well as their own bottom line. It is recommended
that governments:
a) Introduce programs to raise awareness among private employers of the business case
for hiring persons with disabilities.
b) Support employers‘ organizations and networks to share inclusion practices and build
their capacities to harness the potential of employees with disabilities.
Disability-Inclusive Business—a number of large employers should be proactive in
promoting disability inclusion within their businesses. Many of these businesses draw on their
positive experiences of hiring persons with disabilities to demonstrate the business case for
inclusive employment, citing that persons with disabilities:
 Have higher retention and lower accident rates than employees without disabilities,
and comparable productivity;
 Represent an untapped source of skills and talent and transferable problem- solving
skills developed in daily life;
 Often have valuable skills and experiences learned on the job prior to having a
disability;
 Can provide unique insights to help firms to develop their products or services to
customers and clients with disabilities;
 Can improve the company‘s image, increasing morale, creating links to the
community, and appealing to potential customers who have a disability or whose
family members have a disability.
L) Social Enterprises
Social enterprises are businesses that seek to advance a social cause whilst being financially self-
sustainable. Rather than being driven solely by the desire to make profits, these businesses also
aim to maximize social impact. Social enterprises that consciously seek to hire persons with
disabilities, or address issues and barriers affecting the lives of persons with disabilities can
therefore help to boost the employment of persons with disabilities, and also influence wider
social change. Box 10 shows an example of a disability-inclusive social enterprise.
M) Support Persons with Disabilities in the Workplace
Governments can enhance the working experiences of persons with disabilities firstly by leading
by example in terms of public sector employment practices, and secondly by
establishing programs and services that support persons with disabilities to do their jobs
effectively. It is therefore recommended that governments:
a) Promote flexible working arrangements to ensure that qualified, productive individuals are not
unnecessarily prevented from doing certain jobs.
b) Provide funding support and tax incentives to start ups and social enterprise
initiatives that aim to hire persons with disabilities or address specific needs of
persons with disabilities.
c) Provide subsidies or tax incentives that support the inclusion of persons with
disabilities in the workplace.
d) Develop job coach accreditation and training standards and provide job coaching
services to enable persons with disabilities to do their jobs effectively and productively.
N) Building a More Inclusive Society
By creating more accessible physical environments, public transport and knowledge, information
and communication services, governments can facilitate opportunities for persons with
disabilities to work, as well as society at large. It is recommended that governments:
a) Develop and implement accessibility standards for the physical environment in line with
universal design, including public buildings and transport services, to ensure that individuals with
mobility disabilities are not denied employment opportunities.
b) Promote and provide knowledge, information and communication services in accessible
formats, in line with universal design, to meet the needs of persons with sensory, intellectual and
psychosocial disabilities to apply for and retain a job.
c) Foster greater social inclusion by establishing links with disabled persons‘ organizations,
including groups of women with disabilities, and working to promote employment opportunities.
O) Boost Education and Training Opportunities
Education and training is vital for all individuals to develop their human capital, and to acquire
skills and knowledge relevant to the labor market. Governments must therefore ensure that
persons with disabilities are able to access education and training on an equal basis with others. It
is recommended that governments:
a) Make education systems more inclusive, both to make schools more accessible to children with
disabilities, and to modify instruction to meet the needs of all children.
b) Mainstream disability inclusion into technical vocational education and training (TVET)
programs, to support persons with disabilities to acquire knowledge and skills necessary to find
and retain decent work.
P) Break Down Attitudinal Barriers and Challenge Discrimination
Dear students, what are the attitudinal barriers and how can we overcome the
challenges?
Discriminatory attitudes towards persons with disabilities inform and produce other barriers to
the full and equal participation of persons with disabilities in society, including in employment.
For governments to better understand and challenge attitudinal barriers, it is essential to:
a) Undertake research to examine the causes and manifestations of discriminatory attitudes
towards persons with disabilities across society.
b) Launch public awareness campaigns and programs to promote the rights of persons with
disabilities and to challenge discriminatory attitudes surrounding disability.
c) Conduct disability awareness training such as Disability Equality Training for public
employees at the national and local levels.
Q) Improve Data Collection on Disability and Employment
Designing, monitoring and evaluating policies to promote decent work for persons with
disabilities requires timely and high quality information. It is recommended that
governments:
a) Include the six core Washington Group questions on disability in labor force surveys so
that reliable, internationally comparable indicators on employment and disability can be
generated on a regular basis.
b) Conduct disability-dedicated surveys to improve the quality of data and understanding
on barriers to employment and in turn develop more responsive policies.
c) Take a consistent approach to disability identification so that multiple data sources can
be used in conjunction to get a more complete picture of the experiences of persons
with disabilities.