Understanding disability-related costs is critical to building social protection that truly supports inclusion, participation, and escape from poverty for persons with disabilities across the life cycle. These costs are diverse and entail not only a person’s functional hardships, health conditions and support needs, but also the level of accessibility and inclusiveness of their environment, and their ability to participate in certain activities. Social protection systems, therefore, only effectively support persons with disabilities if, in fact, they account for this diversity, understand those costs, and give adequate responses. This webinar was a joint effort to present a way to offer a competitive edge to persons with disabilities by combining different initiatives (concession, cash transfers and care services) to support them in facing the extra costs.
On 29 October 2020, DFAT, UNICEF and UNPRPD organised the webinar “Addressing Disability-related Costs through Social Protection Systems”, a session that presented the diversity of disability-related costs and the role of different methods used to assess them. Supporting the dissemination of a background paper, the presenters discussed practices of accounting for disability costs in the design of mainstream social protection schemes as well as how low- and middle-income countries can progressively build the combination of cash transfers, concessions, and services needed to address them.
The speakers for this webinar were Alexandre Cote, UNPRDP-ILO-UNICEF, Ludovico Carraro, from FCDO-GDC SPACE initiative, Bimbika Sijapati Bassnet and Mercoledi Nasiir, from Prospera Programme, Sawang Srisom, Independent Expert, Josh Wakaniyasi, President of Fiji Federation of Persons with Disabilities, and Felicity O’Brien, from DFAT, as the moderator.
On the importance of considering costs related to disability
Alexandre Cote, from UNICEF, started by giving an insightful presentation about the importance of social protection systems to consider costs related to disability in a comprehensive and committed way. Cote started by explaining the following costs related to disability: 1) the costs of disability related goods and services required by the person that they can afford (which often does not guarantee basic participation on an equal basis with others), 2) the cost of disability related goods and services required to achieve basic participation which they cannot afford and 3) the indirect costs of loss of income in the family due to provision of support and care.
Based on a South African study, Cote points out that for people who seek participation (e.g. studying and working) disability-related costs increase tremendously compared to those who are not included or do not have equal access to participation in society. That is, if someone seeks basic equal participation, they will probably need personal assistance such as sign language interpretation, transportation and all these things come with expenses. Thus, for a person with disabilities the cost of participation raises quickly to four, seven or even 15 times above the poverty line. This evidence highlights that, considering the income distribution in South Africa, very few people would be able to afford basic participation.
Building from these findings, what should be expected from inclusive social protection systems across the life cycle? Cote argues that 1) basic income security; 2) coverage of health care costs including early intervention, (re)habilitation and assistive devices; 3) Coverage of disability related costs including access to support services, e.g. personal assistants or sign language interpreters; and 4) facilitating access to early childhood development, education and economic empowerment programs would alleviate tremendously the extra costs for people with disabilities.
Alexandre Cote also added that one of the key issues is that mainstream cash transfers rarely factor disability related costs, i.e. often disability related cash transfers are poverty/basic income security benefits that do not consider the actual costs of disability. Cote also argues that Universal Health Coverage (UHC) rarely includes assistive devices and rehabilitation. Finally, another challenge would be that concessions are not always designed in a progressive and evidence-based manner to have the best impact possible.
How to factor the cost of disability in SP programmes
To further understand the costs related to disabilities, Ludovico Carraro, from FCDO-GDC SPACE Initiative, focused his presentation on how to factor the cost of disability in social protection programmes. Carraro agreed with Cote in stating that there is an extra cost for people with disability to reach the same level of participation, inclusion, and wellbeing. He added that these costs vary depending on the type and severity of disability, level of income, service provision, price structures, etc. In addition to this, each country is different, and the calculation needs to be tailored to their specific circumstances.
The presentation also showed that many mainstream programmes tailored to people with disabilities determine eligibility based on either income, wellbeing or broad disability allowances provided (regardless of income). For the mainstream programmes, where the eligibility is based on welfare assessment, Carraro explains that some countries are using proxy means testing (e.g. Mongolia, Philippines, Pakistan) in Guaranteed Minimum Income (GMI) schemes (e.g. Moldova) to determine eligibility. For these, he points out, it is important to identify all persons with disability falling below the threshold and their families (identification), and determine the level of support required, assessing distance from the eligibility threshold (support package).
Discussing the case of Mongolia, which uses proxy means testing to determine eligibility, Carraro referred to a 2013 study that assessed the additional cost of disability with the available data. The existing welfare measures were adjusted to consider this extra cost, and the statistical model was estimated. This meant that the proxy considered the situation of persons with disabilities which allowed for many to be included in the food stamp programme. In a similar way, the first step in Moldova was to assess specific costs related to disability in national households. This adjustment therefore also had implications on the level of support provided to each family so that, everything else equal, a household with persons with disabilities received a higher transfer.
Disability allowances are disability related cash transfer programmes in which some countries provide allowances to those with a recognised disability. This is the case in North Macedonia, which has a system that combines means tested benefits for persons with disabilities with some benefits provided to persons with certain types of severe disabilities. Here, Carraro explained that in the presence of disability allowance, means tested support does not need to adjust for the extra disability costs, but should disregard the disability allowance in the means test.
Bimbika Sijapati Bassnet and Mercoledi Nasiir, from the Prospera Programme introduced findings about survey and data collection activities to investigate the extra cost of disability in Indonesia. Bimbika Bassnet started by presenting what kind of concessions would be most useful for promoting economic participation of persons with disabilities. A bilateral initiative, with countries such as Australia, Nepal and Philippines that provide both cash transfers and concessions, showed that the better option would be to identify a form of concessions that would have the highest impact on persons with disabilities and their families and make it as effective as possible.
However, how much would these concessions cost? The bilateral dialogues showed that the budgetary impact of providing concessions through the tax systems would be minimal because only a small percentage of persons with disabilities participate in the formal economy. Besides, not all the funds would have to come from the central government, but also from local governmental and private sector.
Mercoledi Nasiir then explained further how the Prospera Programme in Indonesia was dealing with calculating the extra cost of disability. Their findings show that even before the poverty line was adjusted, households with persons with disability had poverty rates that were two times higher than households with no disabilities (respectively 16% and 8%). After adjusting for the extra cost percentage, the poverty rate soared to three times higher in households with disabilities when compared to those without. Considering these findings, Nasiir proposes three kinds of concessions: top-ups, which could be public transportation cards, prepaid electric meters etc; subsidies, such as insurance premium and assistive devices provisions; and zero-rated import taxes, for imported assistive devices, for example.
The discussion was paused briefly for a live Q&A session which you can access here.
After a short round of questions from the audience, Sawang Srisom, from Transportation for All (T4A), focused his presentation on how social protection systems can address disability-related costs in Thailand. Srisom started by giving an overview of the current social protection systems and programmes in the country. In Thailand, 5.5% of the population or 3.7 million people have a disability (data from 2017). For this part of the population, the country has a pension system (disability allowance) as its main social protection scheme. In addition, essential social services are also designed to target persons with disabilities, providing support such as health care with a universal coverage scheme, independent living, education, food security and housing.
Srisom suggests that, although the Thai government has set up some policies for persons with disabilities, it should still tackle the challenges brought by disability related extra costs. Some of the issues identified are that:
1) these costs are currently not widely discussed or substantiated by law;
2) there is no clear definition of disability related costs;
3) there must be a better understanding about how to measure DRECs based on context;
4) it should develop a social welfare approach and;
5) must adjust payments.
To tackle these challenges, Srisom makes a case for including social protection programmes and DRECs in the next 5-year National Disability Plan (to be discussed in 2021), encouraging more research, discussions, and debates on social protection and DRECs and increasing accessible infrastructure.
For the final presentation, Alexandre Cote gave a quick summary on the case of Fiji. In 2018, the Disability Allowance Scheme (DAS) to all persons with significant disability was added to the already existing social protection schemes available in Fiji. This disability allowance resulted from a consultation between the Government and Organisations for Persons with Disabilities and focuses on disability extra costs with a monthly payment of FJD 90 per month. Persons with disabilities within households eligible for Poverty Benefit Schemes (PBS) are also eligible for DAS. Furthermore, they are eligible even if employed to help cover their extra costs, showing that the criteria to get disability support is not based on the incapacity to work. The Disability Allowance Scheme, Alex Cote says, is not means tested and not yet compatible with old age pension.
By 2020, the DAS reached 1.4% of the working population in Fiji and its representation on the country’s GDP jumped from 0.05% in 2018 to 0.35% by 2020. Besides DAS, a combination of other schemes addressed the extra costs related to disability in Fijian households, e.g. bus fare concession, Economic Empowerment Training, free healthcare in public hospitals and subsidies, housing assistance, etc.
The discussion ended with the second round of Q&A session which you can access here.
This was the second webinar of the Disability Inclusive Social Protection Series. The series is organised by Australia DFAT in partnership with the ILO-UNICEF inclusive social protection initiative supported by the UNPRPD COVID-19 joint program.