Lessons from a Decade's Research on Poverty

1. Disability and Poverty in LMICs:
Some Evidence and lessons learned
Jean-Francois Trani, Parul Bakhshi,
Washington University in St Louis
Lessons from a Decade’s Research on Poverty:
Innovation, Engagement and Impact
Pretoria, March 16-18th 2016

2. 18/03/16 – Disability and Poverty in LMICs: Some Evidence and lessons learned
Outline
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• Introduction
• Methodology: multiple disability studies in
Afghanistan, India, Morocco, Nepal, Sierra Leone,
Sudan, Tunisia
• Main findings
• Concluding remarks
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3. 18/03/16 – Disability and Poverty in LMICs: Some Evidence and lessons learned
Introduction
Kabul, Afghanistan, SCA Rehabilitation Center, 2011
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4. 18/03/16 – Disability and Poverty in LMICs: Some Evidence and lessons learned
Capability approach and Disability
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Introduction Methods Findings Concluding remarks
• Disability is lack of capabilities: poor conversion factors and
lack of agency
• Persons with disabilities are deprived of agency, facing
deprivation resulting from a double handicap: an earnings
handicap and a conversion handicap
• The conversion handicap refers to the extra needs and costs of
living with a disability in a given environment
• Looks at the impact of disability on the family and community
• Promotes the understanding that the poverty of persons with
disabilities comprises social exclusion and disempowerment,
not just lack of material resources.
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5. 18/03/16 – Disability and Poverty in LMICs: Some Evidence and lessons learned
Hypothesis: Barriers to the realisation of people with
disabilities’ aspirations
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• Are People with Disabilities facing barriers that hinder their
participation in social and economic life ?
• In Low and Middle Income Countries, is there wider exclusion
from basic capabilities: health, education, employment,
security, food and shelter, sanitation, social and political life?
• The frustrations and distress that comes with the experience
of exclusion has a toll on the mental health of persons with
disabilities, increases anxiety and reduces self esteem
• Facing inequalities and injustice, persons with disabilities see
their aspirations to a good life shuttered
Introduction Methods Findings Concluding remarks
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6. 18/03/16 – Disability and Poverty in LMICs: Some Evidence and lessons learned
Research questions
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• Are they higher barriers and inequalities faced by
persons with disabilities and are they persistent in all
these countries
=> Measure the gap in economic and social opportunities
and circumstances between disabled and non-disabled
persons at individual and household level
• What are the consequences of these inequalities on the
quality of life and aspirations of persons with
disabilities?
Introduction Methods Findings Concluding remarks
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7. 18/03/16 – Disability and Poverty in LMICs: Some Evidence and lessons learned
Examining data collected over a decade in LMICS
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• Analysis of data from large-scale surveys on poverty &
vulnerability in Low and Middle Income Countries
(LMICs) and in Conflict settings
• Afghanistan 2005 and 2013: Handicap International-
UNOPS-Swiss & French Cooperation / Swedish
Committee for Afghanistan- SIDA,
• Darfur, Sudan 2008: UNICEF
• Sierra Leone, 2009: Leonard Cheshire Disability
• New, Delhi India 2011: DFID
• Nepal, 2011: DFID
• Morocco and Tunisia (2014): Handicap International
Introduction Methods Findings Concluding remarks
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8. 18/03/16 – Disability and Poverty in LMICs: Some Evidence and lessons learned
Collecting primary data to construct a picture of disability
and capabilities
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• Questions about socio-economic family background
• Screening for disability (DSQ34)
• Questionnaires to measure:
 individual conversion factors (characteristics),
 functionings: what people do and choose to be
 existing opportunities and barriers to achieve wellbeing in a given context
considering various domains of capabilities
 norms and values, prejudice and social exclusion
• Looking at access to services, employment, income and assets,
livelihoods, self-perception, social status and social exclusion process
• Prepared by and completed with qualitative work (FGDs…) for
cultural validity
Introduction Methods Findings Concluding remarks
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9. 18/03/16 – Disability and Poverty in LMICs: Some Evidence and lessons learned
Multidimensional poverty in Afghanistan: dimensions &
Cut offs
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Dimension Deprived if… (1st Cut-off)
1. Health status (source of water)
Well in residence/ compound/plot; covered well; open well and
kariz; spring; river/stream; pond/lake; still water; rain water;
tanker/truck;other
2. Love and care Lacks mother's care
3. Family assets Less than 6 assets
4. Food security Often not enough food
5. Social inclusion
At least one incident of mistreatment, no participation in ceremony
and engaged or married
6. Education No education
7. Freedom from exploitation
and leisure activities
Child works more than two and a half hour/day
8. Crowded space More than three people per room
9. Personal autonomy Moderate difficulty to carry out ADL
10. Mobility Moderate difficulty to be mobile
Introduction Methods Findings Concluding remarks
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10. 18/03/16 – Disability and Poverty in LMICs: Some Evidence and lessons learned
Multidimensional poverty in Afghanistan: children
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0
0.1
0.2
0.3
0.4
0.5
1 2 3 4 5 6 7 8 9 10
Non-disabled
Disabled
Greater depth of poverty for disabled children whatever the cut off
Introduction Methods Findings Concluding remarks
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11. 18/03/16 – Disability and Poverty in LMICs: Some Evidence and lessons learned 11
Greater depth of poverty for mentally disabled adults whatever the cut off
0.0
0.1
0.2
0.3
0.4
0.5
1 2 3 4 5 6 7 8 9 10 11 12 13 14
None/mild/moderate
Physical
Sensorial
Mental
Multidimensional poverty in Afghanistan: adults
Introduction Methods Findings Concluding remarks
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12. 18/03/16 – Disability and Poverty in LMICs: Some Evidence and lessons learned
Multidimensional poverty in Darfur Sudan: children
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Greater depth of poverty for disabled children whatever the cut off
0.000
0.050
0.100
0.150
0.200
0.250
0.300
0.350
0.400
1 2 3 4 5 6 7 8 9 10
Non disabled
Mildly disabled
Severely disabled
Introduction Methods Findings Concluding remarks
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13. 18/03/16 – Disability and Poverty in LMICs: Some Evidence and lessons learned
Multidimensional poverty in Darfur Sudan: by gender
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Greater depth of poverty for disabled girls whatever the cut off
0.000
0.050
0.100
0.150
0.200
0.250
0.300
0.350
0.400
1 2 3 4 5 6 7 8 9
Boys with disabilities
Girls with disabilities
Introduction Methods Findings Concluding remarks
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14. 18/03/16 – Disability and Poverty in LMICs: Some Evidence and lessons learned
Afghanistan & India: Mental Illness, Stigma and Poverty
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• Higher level and intensity of multiple deprivations are particularly
associated with mental disability in Afghanistan and with mental
illness in India
• Deprivation of employment and income are major contributors to
M0 in both studies
• Multidimensional poverty is associated with stigma attached to
disability and mental illness
• In turn, poverty erodes self-esteem and brings shame and
acceptance of discriminatory attitudes
Introduction Methods Findings Concluding remarks
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15. 18/03/16 – Disability and Poverty in LMICs: Some Evidence and lessons learned
India: Likelihood to be poor
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• Higher risk to be multidimensional poor for persons with severe mental
illness (PSMI)
• Stigma is a moderating factor that increases likelihood to be poor
• This is even more the case for women PSMI and those from lower castes
Introduction Methods Findings Concluding remarks
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16. 18/03/16 – Disability and Poverty in LMICs: Some Evidence and lessons learned
Afghanistan:
Access to healthcare
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OR (95% CI) P value
Predictor variables
Level 1
Gender Female (ref: Male) 1.00 (0.74-1.35) 0.98
Age 0.99 (0.99-1.00) 0.03
Education (Ref: No formal education) 1.52 (1.05-2.20) 0.03
Ethnicity (Ref: Pashtun) Tajik
Minority
0.83 (0.531.30)
0.99 (0.62-1.58)
0.42
0.96
Type of disability Sensory
Mental and Associated (Ref: Physical)
0.88 (0.62-1.26)
0.81 (0.57-1.15)
0.49
0.24
Asset index 20%-80%
20% richest (Ref: 20% poorest)
1.78 (1.24-2.55)
2.60 (1.61-4.21)
0.001
<0.001
Working for monetary compensation
Working (Ref: Not working) 1.27 (0.89-1.82) 0.18
Cause of disability
Acquired after birth (Ref: By birth) 0.81 (0.61-1.09) 0.17
Year 2013 (Ref: 2005) 0.36 (0.21-0.64) <0.001
Level 2
Time to reach clinic 0.99 (0.99-1.00) 0.59
Village connectivity by a paved road (Ref:
Not connected) 1.23 (0.73-2.09) 0.44
Electricity in village (Ref: No) 1.47 (0.89-2.44) 0.13
District Center Distance 0.98 (0.94-1.01) 0.14
Distance to Road 1.12 (0.97-1.29) 0.11
Distance to Road*Year (ref: 2005) 0.74 (0.58-0.95) 0.02
AIC 1546.2
-LL -753.08
• No difference by gender, age,
cause/type of disability
• Educated people and those
from wealthier HH are more
likely to access healthcare
• Access is worse in 2013
compared to 2005 for persons
with disabilities
• Worse access in remote areas
in 2013 than in 2005.
Introduction Methods Findings Concluding remarks
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17. 18/03/16 – Disability and Poverty in LMICs: Some Evidence and lessons learned
Afghanistan: Access to school
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Level 1 at individual level
•Women with disabilities have 3 times less
chances of access;
•In 2013 all children with disabilities are 4.3
times less likely to access;
•Persons with mental/associated disability
are 2.3 times less likely to access school;
•PwD with known cause are 3.3 times more
likely to access school than when the cause
is unknown.
Level 2 at Village Level
•2.3 times more likely to go to school if there
is electricity in village.
•In 2013, villages poorly connected by
paved road are 5.9 times less likely to send
their cwd to school than those poorly
connected in 2005;
stigma and accessibility issue not
solved.
Introduction Methods Findings Concluding remarks
OR (95% CI) P value
Predictor Variables
Level 1
Gender
Female (ref: Male) 0.32 (0.19-0.54) <0.0001
Age 0.97 (0.95-1.00) 0.11
Ethnicity (Ref: Pashtun)
Tajik
Minority
0.90 (0.47-1.70)
1.03 (0.54-1.95)
0.74
0.93
Type of disability (Ref: Physical)
Sensory
Mental and Associated
0.44(0.22-0.84)
0.43 (0.22-0.80)
0.01
0.01
Asset index (Ref: 20%-80%)
20% poorest
20% richest
2.18 (1.05-4.56)
5.92 (2.57-13.63)
0.04
<0.0001
Cause of disability (Ref: Unknown cause)
Known cause 3.27 (1.92-5.56) <0.0001
Year (Ref: 2005)
2013 0.23 (0.08-0.67) 0.01
Level 2
Village connec vity by a paved road (Ref: No)
Yes 1.87 (0.76-4.58) 0.17
Electricity in village (Ref: No)
Yes 2.27 (1.22-4.27) 0.01
District Center Distance 0.99 (0.93-1.07) 0.94
Distance to Road 0.87 (0.72-1.05) 0.16
Village connec vity by a paved road*Year (Ref: 2005) 0.17 (0.04-0.74) 0.02
District Center Distance*Year (ref: 2005) 1.05 (0.96-1.15) 0.26
AIC 611
-LL -287.51
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18. 18/03/16 – Disability and Poverty in LMICs: Some Evidence and lessons learned
Concluding remarks
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• Negative effect of disability on outcomes linked with various important elements
of wellbeing in all countries: unemployment, access to health, education and
poverty
• in line with WHR: Major disabilities have lasting influences on well-being
• Growing body of research in LMICs showing existence of barriers for persons
with disabilities that are deprived of jobs and other economic opportunities
and experience higher poverty and lower quality of life compared to the rest
of the population.
• Stigma translates in reduced opportunities is a major impediment to flourishing:
low self esteem & aspirations=> issue for public policies
• In such a context, what are the possibilities to enhance persons with disabilities’
“capacity to aspire” and capabilities? (Appadurai, 2004)
Introduction Methods Findings Concluding remarks
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