1. Escaping Stigma and Neglect
People with Disabilities in
Sierra Leone
Working paper 164 – forthcoming
Giuseppe Zampaglione
Mirey Ovadiya
Africa Human Development 2
With support from the Disability and
Development Team
World Bank

2. Objective of the Policy Note
Provide a diagnosis on the scale and nature of the problem;
Analyse current public policies in support of People with Disabilities;
Review public and private programs and;
Propose policy options to policy makers and development partners.

3. A. Diagnosis Poverty a cause and consequence of disability
-Sierra Leone of the poorest countries in the world ranking 176 out of 177 in the UN Human Development Index
-The war had a devastating impact on human capital: gender violence, landmines, deteriorated public health system

4. A. Prevalence of Disability in Sierra Leone
2004 Census prevalence of disability at 2.4%
Likely to be underestimated – Census only captures severe physical disability not including mental disability
Reasonable global estimate is 10-12% prevalence
Estimated 5% of HHs have one or more disabled person
The 2004 Census uses the World Health Organization’s (WHO) general definition of a People with Disabilities as one who experiences any limitation in performing a daily-life activity in a manner considered normal for a person of his/her age, because of a long-term physical condition (i.e. more than six months), mental condition[1] or health problems [1] As defined by the International Classification of Diseases (ICD) published by the WHO.
WHO estimates prevalence of disability in developing countries around 10 percent

5. A. Nature of Disability

6. A. Geographic Distribution
Incidence of People with Disabilities higher in the South and East, and more pronounced in rural areas than in urban ones.
People with Disabilities more concentrated in the Southern (2.9%) and Eastern regions (2.8%), followed by the Northern (2.2%) and the Western (1.7%) regions.

7. A. Access to Basic Services and Employment
Access to Health
Access to Education
Access to Transport/Mobility
Income and employment
Access to Health
National Health Strategy 2002 notes disability as one of the priority health problems in Sierra Leone, although does not prioritize among different health approaches. In particular, it does not address the question of whether public policies should focus on prevention, cure, rehabilitation and mitigation, and in which order of importance or combination
Actual provision of health services to prevent disabilities and rehabilitate People with Disabilities is inadequate
Census data on access to health services are very limited.
Access to Education
New Education Policy as well as the PRSP recommend inclusive education of disabled children in primary and secondary schools while providing suitable facilities for those in need, and developing different approaches to teaching and curriculum that benefit all students.
An inclusive education policy is not yet implemented in wide scale in Sierra Leone.
Disparity between non-disabled and disabled children/youth in school attendance (5 -19 yrs) is 7 % in the case of boys and more than 10% for girls.
School attendance and highest level of education attained seems to be negatively correlated with disability
Access to transportation/mobility
Census provides no specific information on the issue of accessibility, and transportation and mobility services for People with Disabilities
Income and employment
Census data suggests that HHs with people with disabilities are poorer that those without
Employment rates and average earnings are lower among People with Disabilities than in the general population, varying by gender and disability type

8. B. Policy Framework in support of PWD
Legal Framework
Institutional Environment and Policies
Constitution
Parliament
TRC
Human Rights Commission of SL
Ministry of Social Welfare, Gender and Children Affairs
NaCSA
Legal Framework
Despite shortcomings,1991 Constitution and a number of key treaties and Conventions (CRPD) provide an entry point to work towards an improved policy environment in support of People with Disabilities
SL commenced a process to draft national disability legislation with the stated purpose of providing for the “rights and rehabilitation of persons with disabilities” and “to achieve equalization of opportunities for persons with disabilities, to establish the National Council for Persons with Disabilities, and for connected purposes
Quite a number of actors, little coordination, unclear leadership, scarce resources

9. C. Public and Private Programs in support of PWD
Public Programs
NGO implemented programs
Successes to date
Challenges
Funding
Involve more CSO – communities
Strenghten DPOs
Definition
Three key challenges for the future of NGO implemented programs are emerging. The first and critical challenge is to capitalize on the lessons learned and results achieved with the variety of programs implemented by NGOs. Government will need to approach these interventions with a coherent strategy to mobilize resources, rationalize and scale them up according to priorities identified by the People with Disabilities. All national and international sponsored programs are facing some level of funding constraint, which is likely to increase as the donor community is set to reduce its overall support to Sierra Leone.
The second challenge appears to be the weak involvement of local advocacy and civil society organizations in the design and implementation of programs, and the need to build further capacity within local Civil Society Organizations (CSOs) for advocacy, sensitization and program implementation. Many local DPOs feel marginalized and indicate that INGOs do not show adequate willingness to work with small local CSOs.
A third challenge is the ability of local DPOs to monitor the full array of government policies and programs in order to ensure that they do not miss out on opportunities to push for more inclusive policies and programs, and prevent use of resources on non-inclusive programs.
A fourth challenge is related to the very definition of person with disability and the arbitrary distinction between people made disabled by a direct act of violence during the war and people that have acquired a disability which was related with the war only indirectly or had no relation with it, including hereditary or aquired disabilities. To a large extent it was the western media and donors that have developed such distinction. While understandable and morally grounded, the focus on victims of the war such as Fatima depicted in the cover of this working paper, is to be expanded well beyond them since the humanitarian emergency is well over.After all, according to the data they represent a small minority on the total of people with disability. And the stance the paper takes is that basically all people in Sierra Leone were somehow disabled by the war, people such as Fatima, but also the vast majority of Sierra Leoneans that suffered from psychological trauma. Moreover, people who had already a disability, suffered from the lack of support during the war, and in many cases their medical condition deteriorated because of the war. This leads to state that all people with disabilities were victims of the war, whether they suffered from a direct act of violence or whether their condition was pre-existent and the conflict worsened it.

10. B. Definition beyond the emergency
From: People made disabled by an act of violence during the war/ People with a preexistent or war unrelated disability
To : All Sierra Leoneans were disabled by the war and all people with a disability were victims of the war

11. D. Policy Options Grouped as:
(i) measures that will specifically target people with disabilities and
(ii) measures that will work to mainstream disability issues through sector programs.

12. D. Policy Options (2)
The recommended measures are grouped under three categories:
(i) knowledge building and analysis;
(ii) strengthening of the legal and institutional framework; and
(iii) amelioration of public and private service coverage and financing
Knowledge Building and Analysis
Further analysis is needed in the following areas in order to better understand People with Disabilities needs and effectiveness of current programs and to formulate an adequate policy response:
Educational, training and employment opportunities for young People with Disabilities;
Health needs of People with Disabilities including rehabilitation;
Cost/benefit analysis of excluding People with Disabilities from society and the economy;
Cost analysis of the implementation of the draft legislation;
Enhancement of statistical and other data with Central Statistics Office and line ministries to assist with identification and targeting of People with Disabilities to benefit from “free basic services such as health and education” and overall access to assistance programs by a larger majority of People with Disabilities;
Finance assessment of existing programs, expenditures and analysis of their impact on livelihoods of People with Disabilities with specific attention on People with Disabilities the existing social protection schemes to determine which programs deserve to be scaled up and supported with increased financing.
Improving Legal and Institutional Framework
Self-standing and targeted measures
Clarify roles and responsibilities of lead institutions in this area to ensure system wide mainstreaming of disability at highest level.
Implement outreach and training for the Parliamentary Human Rights Committee;
Ratify CPRD and other pending legislation;
Draft Legislation on People with Disabilities:
Improve, finalize and enact the draft legislation on People with Disabilities as an overarching policy framework document;
Operationalize the monitoring and implementation of the draft Act;
Provide technical assistance to the Ministry of Social Welfare, Gender and Children’s Affairs to lead the finalization of the draft Act including outreach in Parliament and Cabinet;
Strengthen DPOs involvement in consultations, monitoring and implementation.
Sensitization and dialogue targeting key sector ministries, Ministry of Finance and Office of the President (??)
Mainstreamed measures
Support adoption of disability policy/action plans by all Ministries including creation of employment opportunities for People with Disabilities within public and private sector;
Provide NaCSA support with a view to boosting its engagement in People with Disabilities issues within its mandate.
Improving Public and Private Program Coverage and Financing
Ensure the draft legislation and policy are fully costed and considered within national budget;
Support scale-up of successful NGO programs (to be identified) to improve coverage of People with Disabilities and improve access to basic services;
Accelerate and strengthen resource mobilization efforts to ensure that priorities are implemented, including, inter alia, the Truth and Reconciliation Commission recommendations for the War Victims Reparations Program.
Sector Ministries: Planning and Capacity Development
Support all sector ministries to integrate disability issues, needs and priority expenditures into their annual sector budget
Emphasize support for prevention measures in sector programs such as nutrition (targeting mother and young children), transportation and road safety (to reduce road accidents), vaccinations and access to basic health services, early childhood development and early detection of disabilities through community based screening and assessment tools
Advocate inclusiveness and community integration in all sector ministry programs especially on health, HIV/AIDS, education, transport, skills training, micro-credit and housing
Enhance dedicated technical capacity on disability issues (disability desks) in key ministries such as education, health, transport, and others such that they are able to effectively participate in the annual sector planning and budgeting process. Involve People with Disabilities in the design, implementation and evaluation of sector programs and policies.
Sector Ministries: Financing interventions benefiting People with Disabilities
Support MEST efforts to increase enrollment and school attendance of children with disabilities through the scaling up of successful inclusive education programs and number of accessible schools;
Support Ministry of Health to scale-up successful rehabilitation programs, include preventive services in basic health care package and focus on longer term decentralized and accessible health care services (??);
Support Ministry of Social Welfare, Gender and Children’s Affairs to scale up successful skills training and employment schemes; and
Consider a disability grant which will work like a pension as part of the national social assistance scheme
Donor program financing
Advise all donors to include/mainstream disability issues in all donor financed/implemented projects.

13. D. Knowledge building

14. D. Coverage and financing

15. D. Legal and Institutional Framework

16. Thanks!