Viewpoint: Disability--the Hidden Side of African Poverty

For many years, poverty and disability have been linked in a "vicious circle." Disability may prevent a person from working, while adding costs in terms of health care, thus making the person more vulnerable to poverty. Poverty, in turn, can be the catalyst of a disability, as is the case in developing countries where disability largely results from preventable impairments associated with communicable, maternal and perinatal diseases and injuries. In Africa, there also is evidence that many people become disabled because they cannot afford healthcare. Malnutrition in its various forms is an additional major cause of disability in Africa where two-fifths of children are malnourished.

Despite this link between disability and poverty, there has been an uncomfortable silence among international development organizations about disability issues. A recent study by Action on Disability and Development, in conjunction with the Chronic Poverty Research Centre in the UK, found very low levels of inclusion of persons with disabilities in the work of international development organizations.

Why the silence?
Why has there been such silence and inaction about disability in the development field? Why have we not seen a disability paradigm or focused international initiative as we saw in the last decade or so in the fields of both gender and health? There are several possible reasons. One important reason is the lack of awareness of the strong link between poverty and disability in the development context.

This lack of awareness is triggered by the general absence of reliable data sources on disability in developing countries, which prevents researchers from documenting the two-way link between poverty and disability. Disability statistics from censuses typically ask questions about impairments and provide estimates that seem very low by any standards. The 1991 census in Uganda reported that 1.2 percent of Ugandans had a disability. That is almost ten times lower than the United Nations' 10 percent estimate of the global disability prevalence rate, and almost twenty times lower than the 20-25 percent of the population of developing countries estimated in 1984 by the UN Secretary General.

If one consults the disability statistics database of the United Nations, low estimates in the 1-to-3 percent range (based on national censuses or surveys) are rather common for African countries. There is no doubt that such estimates bear little resemblance to reality in developing countries. For instance, as part of the recent Education Assessment Resources Program, the Ugandan Ministry of Education estimated that severe mental illnesses (such as schizophrenia, epilepsy, and manic depression) only affected 6 percent of the population. When one adds mild mental illnesses and physical disabilities, one will surely end up far above the 1.2 percent estimate of the Ugandan census.

Better prevalence estimates lead to improved capacity to respond
In the end, what do these numbers have to do with the link between disability and poverty in the African context? Well, better estimates of disability prevalence would lead to an improved capacity to evaluate the magnitude of the link between disability and poverty, giving development organizations a better idea of the fruits that may be reaped when directing available resources towards tackling disability as part and parcel of poverty.

Commonsense policy recommendations can be made based on an acknowledgment of the vicious circle that links disability and poverty. For instance, greater investments in health services to reduce communicable diseases would mean fewer disabilities and, hence, less poverty. Greater access to employment through improved access to education and training as well as investments in accessible educational and worksites could reduce the chances that persons with disabilities become or stay poor. However, as long as we do not improve data and estimates of disability prevalence in Africa and until we build concrete evidence on the impact of poverty on disability and vice versa, it is likely that the disability dimension of poverty reduction work will remain a marginal field in the development context.

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