Monday, February 7, 2022

Disability Inclusion in Nigeria: An Assessment by World Bank Group


 According to the World Health Organization, in 2018, about 29 million of the 195 million people who comprise Nigeria’s national population were living with a disability. Data from the 2018 Nigeria Demographic and Health Survey reveal that an estimated 7% of household members above the age of five (as well as 9% of those 60 or older) have some level of difficulty in at least one functional domain—seeing, hearing, communication, cognition, walking, or self-care; and 1% either have a lot of difficulty or cannot function at all in at least one domain. These estimated rates, while significant, are probably even higher because currently available data likely underestimate the prevalence. 

The prevalence rate of disabilities is expected to increase due to the impact of aging, war, conflict, natural disasters, and forced displacement, among other factors. As a group, persons with disabilities are more likely to experience adverse socio-economic outcomes and face higher rates of multi-dimensional poverty than the general population. They encounter attitudinal and environmental barriers that hinder their full, equal, and effective participation in society. Their lower rates of economic and labor market participation impose a greater welfare burden on governments and highlights the costs of exclusion, which range from about 3% to 7% of gross domestic product (Buckup, 2009). 


Disability-inclusive development directly responds to the World Bank’s twin goals of ending extreme poverty and promoting shared prosperity; it is also directly linked to the Human Capital Agenda. The global development and poverty reduction agenda will not be effective unless it addresses the socioeconomic inequality of persons with disabilities and ensures their participation in all stages of development programs. 


Nigeria recently signed the national-level Discrimination of Persons with Disabilities (Prohibition) Act 2018 — a major disability inclusion milestone indicative of the Nigerian government’s increasing prioritization of disability mainstreaming. Prior to the signing, a few Nigerian states had enacted similar laws, which are currently being implemented to varying degrees. There is no existing documentation of progress made to date or of lessons learned from the implementation of these laws, which could otherwise be drawn on for the implementation of the national law. 


Doing nothing to address the challenges faced by persons with disabilities in Nigeria will have consequences for individuals as well as for the country as a whole, which bears the greatest burden. Given the vicious cycle of disability and poverty, excluding persons with disabilities from accessing basic services would impact the country’s economy enormously.


The Nigerian government has expressed a strong interest in working with the World Bank to strengthen programs and services for persons with disabilities. The World Bank’s Social Development Global Practice, in collaboration with the Nigeria Country Team, under￾took a rapid social assessment to better understand the challenges around disability inclusion across the various types of disabilities and to identify drivers and opportunities for inclusion that could be leveraged in a development context. 


Summarized below are the study’s findings regarding the prevalence of disabilities, stigma and discrimination, education, health, community-based rehabilitation, assistive devices and technology, employment and social protection, public information and communications, electoral and political processes, public transportation, legal frameworks, and the institutional landscape.


Availability of Data 

Disability-related data are sparse in Nigeria. Data collection challenges include the government’s low prioritization of collecting disability-disaggregated data and the lack of expertise in the collection process. Utilizing a disability/impairment approach known to yield low results (NPC, 2009), the 2006 Nigerian population census reported a disability prevalence rate of 2.3%. In 2011, a national baseline survey conducted by the Federal Ministry of Women Affairs and Social Development documented a similar rate: 3.2% (FMWASD, 2011). 


Nigeria’s General Household Survey Panel 2010–11 also documents a 2% disability prevalence rate (Leonard Cheshire, 2018). The panel used the Washington Group on Disability Statistics “Short Set,” a set of questions based on the framework of the World Health Organization’s International Classification of Functioning, Disability, and Health and commonly referred to as the Washington Questions. The low rates may be connected to unreported alterations to survey instruments, such as screener or introductory statements, cultural barriers around mentioning functional difficulties, and differences in the training of interviewers (Leonard Cheshire, 2018). The 2012–13 edition of the same survey has not yet been analyzed with a disability lens, and the survey’s third wave (2015–16) only collected data on vision difficulties. 


In 2018, for the first time, the Nigeria Demographic and Health Survey included questions in its disability module that were based on the Washington Group’s Short Set. The survey’s estimated disability prevalence rate of around 8% is still significantly lower than the World Health Organization’s 2011 estimate of around 15% of the global population (WHO and World Bank, 2011).


Stigma and Discrimination 

Persons with disabilities in Nigeria face stigma and discrimination in the form of negative attitudes among family and community members, name-calling, and wrong beliefs about the causes of disabilities, which results in low self-esteem, depression, and isolation. Cultural beliefs around gender roles that favor males magnify the challenges of women and girls with disabilities, who may not meet the norms in terms of beauty or of being a wife and mother, compounded by the myth that women with disabilities will give birth to children who also have disabilities.


Education 

Education is inaccessible to persons with disabilities due to the lack of adapted learning materials, inadequately trained teachers, school shortages, a physically inaccessible school environment, and inaccessible communication. Inclusive education is typically thought to aid social inclusion, but participants expressed reservations about learning outcomes and the full participation of children with disabilities when school environments, teaching staff, and supports cannot adequately meet the needs of students/pupils with diverse disabilities, such as by ensuring sign language immersion. Hearing impaired participants were particularly concerned about the development of sign language as their mother tongue, and participants with visual disabilities pressed concerns over the availability and use of braille documents, particularly at the primary level.


Health 

There is dearth of research into the accessibility of health facilities across the country. One study reported that 71% of respondents with disabilities in the states of Kogi and Niger were unable to access needed health services (Smith, 2011). Study participants with disabilities reported inadequate access to health services characterized by negative attitudes among health workers toward persons with disabilities, ignorance of health workers regarding disability issues, the prohibitive cost of care, inaccessible information and communications, and inaccessible environments and equipment. 


Community-based Rehabilitation 

Community-based rehabilitation (CBR) projects are currently limited in Nigeria. Participants were only aware of a few such projects in the states of Zaria and Kaduna. However, previous studies documented successfully implemented CBR projects in Nigeria. The adoption of CBR principles and community development projects can stimulate improvements in living conditions, self-esteem levels, and community acceptance of people affected by leprosy. Key to a robust CBR program are staff training in the principles, adoption of rights-based approach, program ownership, effective collaboration with government, and multi-sectoral partnerships. However, efforts will not be sustainable if persons with disabilities remain economically dependent on the program and if partnerships remain weak.


Assistive Devices and Technology 

Study participants claimed that assistive devices and technology are not readily available, and if available, are unaffordable because they are imported. Nigeria lacks the expertise needed for the local manufacturing of quality assistive devices and technology. Current attempts are small in scale, obsolete, and often inappropriate for the intended users.


Employment and Social Protection 

Attitudinal and physical barriers are among the major challenges that prevent persons with disabilities in Nigeria from obtaining gainful employment. These barriers result in the denial of job opportunities, inappropriate job placement, lower expectations at work, a lack of reasonable accommodations, non-inclusive human resource policies, inaccessible workplaces, and denial of leadership roles. Women with disabilities may be even more marginalized due to “beauty” standards required by some employers and because they have fewer opportunities to pursue an education or develop skills. These factors may partly explain Leonard Cheshire’s (2018) finding that there were no Nigerian women with disabilities in managerial positions compared with 0.9% of women without disabilities. 


Despite the disproportionate impact of poverty on persons with disabilities in Nigeria, social protection schemes do not adequately include them, and there are no tailored interventions to reduce the impact of poverty. The internal bureaucracies of the organizations of persons with disabilities and a lack of accountability among their leadership further negatively impacts access to social protection.


Public Information and Communications 

Public information and communications especially on websites of public organizations and the various ministries, departments, and agencies are seldom accessible to persons with disabilities in Nigeria, particularly those with cognitive or sensory impairments, including people with albinism. Findings indicate that public information and communications are not available in accessible formats, such as in sign language, easy-to￾read and plain language, audio, and large print. High levels of illiteracy among persons with disabilities and the poor quality of sign language interpretation services further contribute to the inaccessibility problem, along with other factors.


Electoral and Political Processes 

Nigeria’s electoral and political processes are characterized by inadequate knowledge regarding disability inclusion among Independent National Electoral Commission (INEC) staff; inaccessible election procedures and facilities, and a dearth of opportunities for persons with disabilities to participate in politics or to serve in leadership roles. In addition, the implementation of the INEC’s Framework on Access for Persons with Disabilities in the Electoral Process is inadequate.


Public Transportation 

Study participants cited multiple barriers to transportation, including inaccessible vehicles and negative attitudes toward persons with disabilities among commercial drivers and co-passengers. Regarding the aviation sector, participants reported discriminatory attitudes among airline and airport staff, driven by an approach that views passengers with disabilities as ill and incapable of caring for themselves while onboard. Participants also reported examples of being denied accessible parking, damaged assistive devices, and fees for assistance services.


Legal Frameworks 

The study documents existing legal frameworks and policies that specifically target or at least include persons with disabilities. Eleven states: Plateau, Lagos, Ondo, Jigawa, Anambra, Nasarawa, Ogun, Kano, Bauchi, Kogi and Kwara have enacted disability laws, each at a different implementation stage. Multiple factors are cited as having facilitated the implementation of the recently passed national-level Discrimination against Persons with Disabilities (Prohibition) Act 2018 (FRN, 2019), including political will, the creation of an implementation committee and framework, the establishment of an independent commission, pressure from civil society, the active participation of persons with disabilities, and a strong disability movement. 


Institutional Landscape 

Nigeria’s civil society is weak with regard to disability inclusion. Disability inclusion is also not a priority for government ministries, departments, and agencies in their policies, budget allocations, basic services provision, programs, and infrastructure. The newly established Federal Ministry of Humanitarian Affairs, 

Disaster Management and Social Development, which now has the mandate for disability inclusion, has an immense opportunity to enhance technical capacity on disability know-how/expertise in the ministry to spearhead this agenda. There is a shortage of disability-related service providers, and the few available services are provided by private individuals and organizations, which are often unaffordable and concentrated in large cities. Assistive devices and technology are expensive and not readily available. Capacity development and local production are key to increasing such availability.


Conclusions 

This rapid social assessment was undertaken to document the current socio-economic status of persons with disabilities in Nigeria. Findings indicate that persons with disabilities lack access to basic services and that attitudinal barriers represent a major impediment to their socioeconomic inclusion. Inclusive policies are either nonexistent, weak, or inadequately implemented. There is an urgent need to improve the current socio-economic situation of persons with disabilities in Nigeria.


Recommendations 

1- Target households; communities, including religious, traditional, and opinion leaders; schools; the media; and the general population with measures to reduce the stigma associated with disabilities and persons with disabilities, which is based on misconceptions and negative attitudes.


2- Tailor needed capacity development to improve the current disability inclusion principles and practices in various sectors of the economy to relevant stake￾holders, such as government officials at the policy￾and decision-making levels (duty bearers), service providers, development and humanitarian actors, persons with disabilities, parents and caregivers, and organizations of persons with disabilities.


3- Support the generation of disability-related data, which is urgently needed to inform the planning and funding of disability-inclusive programs and services in Nigeria.


4- All levels of government as well as development partners should allocate adequate budgets or increase budget allocations to disability-inclusive policies, programs, and services. They should mandate that their implementation partners and key stakeholders in private and organized sectors do the same.


5- Establish national and state platforms to coordinate a disability-inclusive response, which is critical to creating a synergy among stakeholders, including persons with disabilities.


6- Invest in the local manufacturing of assistive devices and other technology and the development of the needed expertise to produce and use such resources.


Download the full report for critical reading: https://openknowledge.worldbank.org/handle/10986/34073#:~:text=This%20rapid%20social%20assessment%20was,impediment%20to%20their%20socioeconomic%20inclusion.



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