The COVID-19 crisis has shown that there are many gaps to be overcome towards inclusive social protection delivery. At the same time, considerations of cost-effectiveness and complexity of implementation have sustained the debate around standards for eligibility determination. In the case of persons with disabilities, the current scenario exposes the necessity to extinguish common barriers.

This blog summarises the exchanges and key messages raised by the expert panel at the webinar ‘’Disability identification, assessment, and determination in social protection systems: barriers to access and gateways to support’’, held on 17 November 2020 and jointly organised by the Australian Government's Department of Foreign Affairs and Trade (DFAT), the United Nations Partnership on the Rights of Persons with Disabilities (UNPRPD), the United Nations Children's Fund (UNICEF) and the International Labour Organization (ILO).

The webinar featured contributions by Alexandre Cote (UNPRDP-ILO-UNICEF Inclusive Social Protection Initiative), Josh Wakaniyasi (Fiji Federation of Persons with Disabilities), Ketevan Melikatdze (UNICEF Georgia), and Donna Koolmees (USAID OKARD project Laos). The session was moderated by Felicity O’ Brien, from the Social Protection Section at DFAT.

You can access the presentation slides and watch the webinar’s recording.

Speaking on the considerations for cost-effective disability assessment and determination mechanisms, Alexandre Cote started by highlighting that social protection is a central element in guaranteeing full enjoyment of social and economic rights for persons with disabilities. One of the main challenges faced by government actors interested in implementing inclusive social protection across the lifecycle is the issue of eligibility determination. When it comes to disability assessment and determination, an official process is often required, and three main cases can be observed: (1) Basic identification of households where persons with disabilities are likely to reside; (2) Assessment for granting the official disability status; and (3) Assessment determination for eligibility for specific benefits.

Influenced by the Convention of the Rights of Persons with Disabilities (CRPD) committee and its recommendations on the subject, countries are increasingly reforming their national systems to incorporate a human rights-based model for disability assessment and determination. A fundamental component of the model and the CRPD group of recommendations is to shift away from the ‘’incapacity to work’’ paradigm and focus instead on the barriers and lack of support in the environment that prevents a person from fully participating on an equal basis with others.

Disability assessment and determination is critical, and the focus should lie beyond the tools being used and rather on the political-economic aspects of the reform and the interest groups involved:

 

Unbundling key concepts

It is important to distinguish between disability assessment and determination which are often framed together. While disability assessment refers to the gathering of information on the situation faced by the person, disability determination is the official decision based on that assessment and determination criteria. Disability assessment can also inform broader eligibility determination for services beyond disability:

 

Disability certification and data

In seeking to reduce the disability burden of undergoing many assessment processes to access different services and benefits, disability certification has emerged as a common practice along with the issuing of disability cards. To avoid stigmatisation, such cards may receive different names (equal opportunity card in Senegal). Usually, they guarantee access to a basic package of benefits and can also inform eligibility determination at large.

Most importantly, the discussion around certification shows how countries have the chance to make the most out of the information gathered during disability assessment to build information systems that will support case management and policy planning. Once aggregated and analysed, the data already collected for determining the disability status of individuals and eligibility to benefits will let the government know what disability needs are faced. Moreover, by connecting a disability registry with a single registry, persons with disabilities can be better included in the provision of broader social protection.

 

What should be assessed?

In short, disability assessment should balance comprehensiveness and simplicity. What is assessed is the situation of the person in relation to the environment. Nevertheless, disability determination should be based on elements that are somewhat constant to avoid the need for multiple assessments. Additionally, disability determination will not necessarily use all the information collected as part of the assessment. As a result of ongoing discussions, a consensus is being built around the fact that determination should be based on a functional approach (assessment of functional limitations independent of environmental factors) in addition to considerations of support needs.

The issue of medical assessment cannot be disregarded as it poses a barrier in many cases due to the costs involved. In countries where medical assessment is a requirement, it has been increasingly employed as a measure of verification only. Based on these experiences and considerations, the following multi-step approach is proposed:

 

Fiji’s DPOs-government collaboration for disability assessment and determination

Looking into the case of Fiji, Josh Wakaniyasi highlighted the advantages of consulting and working together with organisations of persons with disabilities (DPOs) to design the country’s disability assessment and determination process. In fact, consultation with DPOs is mandatory for all government-funded programs for disability in Fiji. It renders government and DPOs more confident in the processes undertaken as part of assessment and determination.

Fiji figures among the countries where medical assessment is used as a last resource and for verification purposes only. Determination is based on a functional approach and support needs. The process of designing, piloting, and rolling out the assessment and eligibility determination is described below:

 

Reforming Georgia’s disability assessment and determination

The current situation of disability assessment and determination in Georgia is still far from what UNICEF seeks to achieve with its proposed transformation. As described by Ketevan Melikatdze, the system in place solely relies on medical diagnosis and considerations of functional limitations are generally not taken into account, leaving numerous groups uncovered by disability benefits. Furthermore, the government lacks evidence on individual needs and the information that is available is limited.

The plan developed in collaboration with UNICEF predicts a multi-sectoral and multi-dimensional approach that complies with CRPD’s recommendations. Based on a functional assessment, the status seeker would go through a three-tier examination (see the figure below). In this new scenario, medical assessment would serve the purpose of verifying the functional profile.

 

Case management in Lao PDR

To conclude the webinar, Donna Koolmees described the conception and administration of a Needs Assessment Tool for Community Based Inclusive Development (CBID) in Laos as part of USAID’s Okard Project. The CBID modular tool is digital and was designed to support case management by community facilitators. The data is collected across different age groups and modules (such as Economic Participation and Utilization of Health Services) resulting in a customisable database that can be used for different services.

Despite the complexity of assessment, the tool is easy to use, although prior testing and remote technical supervision are key. The tool was successful in helping identify needs and its method for determining red flags using trigger questions proved to be effective. Additionally, collaboration with health partners was crucial for data collection as community workers can face limitations identifying conditions. Lastly, digitisation facilitated updating and accessing the information. By showcasing the lessons learned, Donna Koolmess hoped to make the case for the development of tailored Needs Assessment tools across different country systems.

 

The panellists answered audience questions sent throughout the session. Watch the full recording here.

 

This was the third webinar of the Disability Inclusive Social Protection Series. The series was organised by Australia DFAT in partnership with the ILO-UNICEF inclusive social protection initiative supported by the UNPRPD COVID-19 joint program.  

Social Protection Programmes: 
  • Social assistance
    • Social assistance - General
    • Social transfers
      • Cash transfers
      • In kind transfers
  • Social insurance
    • Disability insurance 
Social Protection Topics: 
  • Single registry/Unified database/MIS
  • Social protection systems
Cross-Cutting Areas: 
  • Disability
  • Human rights
Countries: 
  • Global
Regions: 
  • Global
The views presented here are the author's and not socialprotection.org's