Oral evidence: Disability and Development, HC 947Tuesday 14 January 2014

Oral evidence, 14 January 2014.

Witnesses

Bob McMullan, former Australian Parliamentary Secretary for International Development Assistance, Lorraine Wapling, disability and development consultant with experience at AusAID and DFID, and Dr Susie Miles, Senior Lecturer in Inclusive Education, University of Manchester, gave evidence.

Chair

I thank you for coming and giving evidence to us. First of all, for the record, can I ask you to introduce yourselves?

Lorraine Wapling

Good morning, my name is Lorraine Wapling and I am a consultant in international disability and development.

Dr Miles

I am Susie Miles. I currently work at the University of Manchester teaching inclusive education, but I have worked for a long time in Southern and Eastern Africa on disability issues.

Bob McMullan

I am Bob McMullan. I used to be in the Australian Government dealing with these sorts of issues. I am now just a private citizen living and working here in London.

Chair

Thank you. It is some time—more than a year—since this Committee took the decision in principle that we would conduct an inquiry into disability and development. There is some evidence that DFID has taken that into account over the last year. Certainly the Parliamentary Under-Secretary, Lynne Featherstone, has made a declaration that she wants DFID to be a world leader in disability-inclusive development, which is something that we would welcome. However, we also recognise, from the evidence that we have just had, that there would be a lot to be done to achieve that. There seems to be recognition by DFID that Australia is slightly ahead, and from other evidence we have heard, in some areas, so is USAID. It is good, of course, that DFID is prepared to learn and co-operate with other donors on that front. At the moment, they have made declarations about accessibility of school buildings, improving data, which was raised in a previous one, and funding civil society organisations, which again has been indicated is not as easy as it might be. What do you think DFID would need to do to move from where it is now to the rather ambitious claim of the Minister, to be a world leader—apart from follow Australia’s example, of course?

Bob McMullan

Thank you very much. Having the ambition is a great start. There will be different paths but the key elements are, in some way, to have an overarching strategy. People use different words in different organisations, but to have some overarching document that says, “We want to have the world’s best practice,” that therefore prioritises this as part of the activities of DFID is important in itself. I will come to some content things briefly in a moment.

Chair

There will be another question specifically on that.

Bob McMullan

Let me say then why I think it is important. It sends messages to external bodies that liaise with DFID. What I found surprising in what was then called AusAID was the extent to which it sent a message inside the organisation and led to organisational change in the agency itself. That was not in my head when we started but, in hindsight, it was the most important thing and it happened as a by-product of what we set out to do with the strategy and the way we set about doing the strategy, which was a very extensive consultation with disabled person’s organisations and setting up an advisory group of people with disabilities and experts in that area. That overarching document—as you say we can talk about its substance— its existence and the way you go about setting it up, is the most important thing you can do.

Lorraine Wapling

I would like to support that and maybe take it a step further and say that public declaration, public announcement and public commitment to working towards disability inclusive development is really important, because it sends a message to other international organisations that you are working with and wanting to influence. The scale, scope and nature of the problem are important. It is acknowledging that this is a significant development issue. If you want to tackle poverty, education and all of those things, you have to understand that disabled people need to be included. If you make that public declaration, it influences the internal organisation itself but it also sends an important message to other development actors, and that is also very important.

Dr Miles

I endorse all that has been said in terms of making it part of every act of development. It is not a separate or a specialist issue, and it must not be sidelined as such. I do not think I have a great deal to add, other than to endorse DFID’s stand because it is a very influential player.

Chair

What we wanted to tease out during this session are specific things that you all think DFID could do, because they are at the start of this process and it would help the inquiry. One other thing, mentioned in the previous evidence session—we are aware of it ourselves—is the stigma, which leads to disabled people being hidden away and discriminated against. We had evidence from Sightsavers, which said, “A lot is invested in changing societal perspectives on gender, and many interviewees commented that disability should get a similar amount of attention.” Do you think that is the right approach or is something slightly different required?

Bob McMullan

It broadly is; I would not want to take the analogy too far but, to the extent that it is about changing social values, there is a lot to be learnt from what was done in the area of gender—not that there is not still a lot to do there. In some countries, people with disabilities in families are hidden away, and even where families love them just as much as they do in our country, if there are no resources for support, they wind up, particularly people with mental illnesses, not leaving the house. There are some terrible stories from Indonesia, not because of any peculiarities about Indonesia but because they have studied it better than some places. It is not that the families do not love their family members with mental illness but that they do not have any support to provide them with the assistance to participate in the community. So, yes, we have so far to go in changing attitudes, but in the developed world we need to change our attitudes so that we engage with this. The poorest of the poor are people with disabilities in developing countries, and if our development programmes are not targeting them, we are missing the point.

Dr Miles

Again, I endorse attitude change as the key issue—probably the hardest. I do not like to think of it as just families hiding children away; it is about the attitude throughout society and sometimes at a very high level, in UN agencies even, that needs challenging.

Lorraine Wapling

By making a strategic commitment to disability-inclusive development, by having a strategy and a framework, you are making the issue of disability something that is moving away from only focusing on impairment, which is what tends to happen. It is showing that this is an important development issue. That helps change the mindset. In my work, often with agencies and mainstream organisations, we do an initial session that asks people to say what disability means to them. It helps to confront people’s attitudes towards how they conceptualise and frame disability, and a lot of the words and phrases that come out of that, even from DFID officers and senior managers, still reflect an attitude that disability means something to do with impairment. Therefore, when you are thinking about an agency or an organisation wanting to become more disability inclusive, working on what people think disability means seems like a significant first step, because it helps to challenge that assumption that disability is only an impairment issue. That is why the issue has not really been significant in development up to this point, until something like the UN convention comes along and makes it much more public. People are much more aware that disability is a rights issue; it is not just an impairment issue. Until you challenge that at the core, the agency or organisation cannot move forward with disability inclusion because there is still an assumption that disability is just about specific impairments—a health issue or whatever. As a social development adviser or governance adviser working in fragile states, why do I need to think about disability? By confronting that attitude and understanding that it is not only a matter of people’s impairments, the agency can begin to move forward. That is one of the things that AusAID did quite well, and the strategy that they developed and the consultation process helped to change attitudes within the agency itself, which is a very important first step.

Dr Miles

Your question was about gender mainstreaming, the relevance of disability mainstreaming and the lessons that can be learnt. There are parallels and it would be great to have disability mainstreaming. However, it is very clear what gender is; disability is much less clear and well defined, and differently defined in different contexts. As Lorraine says, we need a greater appreciation of the barriers faced, according to the particular impairment and the social context in which we are talking, as there is so much. It is not as simple as just saying, “Disability mainstreaming, like gender mainstreaming.”

Mr McCann

We understand that AusAID began their programme by focusing on two sectors and four countries. DFID has a large number of programmes across the globe. Where should it start?

Bob McMullan

AusAID, as it was, had a large number of programmes across a large number of countries too. It was not as big as DFID but we did have to prioritise. It is the right question but there is no perfect answer to it. When we choose education and infrastructure, we could have chosen several other areas equally well. It was a combination of the advice we received from consultation with disabled people’s organisations, whether we had the capacity to contribute and some of the countries where we saw we were most likely to be effective. We were conducting a bit of a trial to see how this idea of prioritising the issue of disability inclusive development would work. We felt we could not immediately do it everywhere, so we felt the need to prioritise in both sectors and countries. Ultimately, that is not what you should do; you do it everywhere. But we felt that we had to start with some caution as a test case. The strategy is essentially based on the idea that ultimately everything we do in every country will be tested against its appropriateness for disability inclusion, and the special things we do to assist people with disabilities will be done everywhere. DFID has a different geographical remit, so quite where it would choose to go were it to prioritise is not for me to say, but I do not think, in the long term, you would develop a strategy based on particular sectors or countries. However, like all big journeys, you have to start somewhere, and that was how we thought we could start in a way the institution was able to manage. DFID, what was then called AusAID and USAID are big agencies, but you cannot turn them on a sixpence. You have to have a planned strategy for change and you have to prioritise. I think they turned out to be good choices but I do not want to pretend that they were the only choices, particularly with regard to countries. There is no country in which you could not properly prioritise this.

Lorraine Wapling

The consultation process itself, because it was so widespread and detailed, gave AusAID the opportunity to make a selection, both in terms of country and the sectors that they wanted to focus on. For me, it was logical to narrow it down and say, “We are going to put specific resources, time and energy into these countries and sectors,” because it enabled AusAID to start to make that organisational transition, to build up the evidence base that it needed to expand and to put in place the support mechanisms that are definitely needed. Therefore, it was logical to make those decisions. The exact nature of those decisions came from the consultation process itself. If DFID were to do a similar kind of thing, I would definitely recommend a good broad-based consultation process happened, and then allow DFID to narrow down the potential. The other thing is to look at where you already have good practice happening. When I look at mainstream organisations or other agencies that have tried to mainstream disability, one of the things I notice is that it tends to be more successful if they build on things that are already successful. Looking at something that DFID is already quite well known for or in a country where there is already a good connection or collaboration with a wide range of stakeholders tends to be more successful in adding something like disability inclusion. You already have an advantage there; you already have a good reputation. This is about improving your effectiveness. I have seen that working with mainstream organisations and potentially with DFID as well; it looks to things where it has its own comparative advantage and makes that better. That is easier to communicate as well.

Chair

Do you have any specific examples in mind?

Lorraine Wapling

For DFID or for mainstream?

Chair

For DFID.

Lorraine Wapling

In DFID it is difficult to find specific instances of mainstreaming with disability. In Rwanda, where they introduced social protection and they then began to add a disability component to social protection, it was really well designed. That was a good consultation process. DFID had a good relationship with the Rwandan Government and that gave them opportunity to have good discussions, as was the case in Zimbabwe and a little in Nigeria too. Where you have good relationships and it is possible to talk at that bilateral level with your Government, where there is trust, it presents good opportunities.

Dr Miles

As an educationalist with development experience, I think you have a great opportunity, with the post-2015 discussions and the sustainable development goals coming with hopefully a much greater focus on equity, to make education a main focus. I have the good fortune at the moment to be working with colleagues in DFID developing a topic guide on inclusive education, so I am conscious of some of the blockages or common resistance in the system to opening up to this issue. There is a lot of fear around what it would imply. Recalling joining Save the Children in 1987 on a two-year contract, as the first and only regional disability adviser for Southern and Eastern Africa, I remember saying to the Director, “It is a two-year contract.” He said, “No. This is a 20-year commitment.” It is really important to see this in the very long term. There is a lot to be done.

Mr McCann

Can I direct my last question to Bob? It is about AusAID and it is a direct question about resources. How did you allocate your resources between different disabilities, and what proportion of the aid programme is devoted to disability?

Bob McMullan

There was not a very big extra budgetary commitment specifically for disability. There was some staffing devoted specifically to disability, which is still there. There was a particular attempt to ensure the programmes we had, on which we were already spending money, were redesigned so that they were more disability specific or inclusive. We were already doing some things with regard to these particular disability services, so they were enhanced. There were also things that cost very little. For example, in our volunteer programme we made a particular effort to ensure there were people who could provide services to people with disabilities. I remember seeing in Samoa the first teacher who was introducing sign language into a school in Samoa, who was an Australian volunteer who had gone there and was opening up education to a group of people who had never had a chance, effectively, to have it before—and not because of a lack of interest from the Government of Samoa, which is very good on this issue, but because they just did not have that resource. So, some things cost nothing. I do not want to say it costs nothing, because once you go down the route of disability inclusive development, some things get more expensive. To give you an example, low-rise buses are more expensive than buses that are not specifically designed for people with disabilities. They cost more money. There is no hiding that, but none of us would have buses on which you hung a sign saying people of a particular race or religion cannot get on the bus so we should not buy ones that people with a disability cannot get on. However, it does cost more. I do not want to pretend there is no cost, although it was less than we feared.

Sir Tony Cunningham

Analysis by AusAID suggests that international aid may only reach around 4% of disabled people. Could you give us some idea of how this statistic was calculated?

Bob McMullan

I did not do it myself but it was peer reviewed. Let me give you a bit of background to it and then talk about its consequences. You will have to bring in others more expert than me to give you the detail of how it was worked out. We did think that one of the things that was lacking was a lack of research in this area. That had two features. One was mentioned by Mahesh earlier, and one that you mentioned, Mr Chairman, was about disaggregated data, so that is already on your agenda. In the Australian Government aid programme’s research programme, we had a specific stream in the research programme about research into disability and development, so there was money available for people internationally to bid for to look at research issues around disability and development, because we do not know enough. What does show up is that, unless you review your current programmes and ensure your future programmes are sensitive to the needs of people with disabilities, most times they will miss out. I cannot validate the 4% figure myself; it is not research that I did but it is exactly consonant with the on-the-ground experience—that your education money does not go to children with disabilities unless you do something in particular to make sure they can take advantage it. That is true for infrastructure. Someone earlier gave an example that is consistent with my experience. If you build a new road but you do not develop a mechanism for people with wheelchairs to be able to get along the footpath, that means that money is disadvantaging them. They used to be able to go along as badly as everyone else on the rough track; now they are the only ones that cannot get along the road. That is what drives the 4% figure, but you would have to get someone smarter than me to back up the number.

Chair

One of the things that we are very aware of is that in developing countries issues of diseases and illnesses that cause disability are even more prevalent than they are in developed countries. I wondered whether you all had thoughts about where prevention comes into this. Edwin mentioned rubella, but obviously there are many things, like mumps, measles, meningitis and these kinds of things, that lead to disabilities. Where do these fit into the disability strategy? This obviously helps to prevent people becoming disabled as well as to support them when they are. My understanding in terms of AusAID was that prevention was effectively moved into the health sector rather than included. What was the thinking behind that and what are the advantages or otherwise of taking that approach?

Bob McMullan

To some extent, I am the wrong person to ask this question but I am pleased to be asked it. My view is not entirely representative because the reason it was moved out of the disability programme in the original strategy was at the request of disabled people’s organisations. Their view was that—and intellectually there is no question there is validity in this argument—the prevention of river blindness is a health question; it is not a question about disability. In one way that is true. Take a person with cataracts who has had an operation and before could not see but now can—is that services to people with disability or is it health? What I am saying is that the dividing line is very blurred, but it is clear that the majority thinking of disabled people’s organisations it that they would like to see prevention conducted under the health programme. I do not have a view about how it should be done, but I am absolutely of the view that it is an essential part of a development programme—whether you call it part of your disability aspect is an argument about semantics to me. However, it is fundamental that you deal, concurrently, with the issue of prevention and particularly in things like avoidable blindness, rubella, the emerging issues around diabetes and things like this. They are going to cause a massive increase in disability in developing countries unless we do something about it. It is a fundamental part of a development programme going forward, but you would get a lot of argument about whether it should be in the disability part. I am agnostic about that.

Dr Miles

This is the place to reiterate that disability is a cross-cutting issue; it does not belong in any one sector. It is terribly important that the sectors collaborate. I would like to raise one particular example that I have direct experience of: running clinics in Swaziland many years ago, looking at otitis media. I was essentially looking at profound deafness at the time and supporting parents in improving the intake of the school for the deaf at the time. But it was the sheer quantity—times by 10 or even 100 of children who had severe or chronic otitis media, which was the case in this country until our nutrition improved after the war; it was not the antibiotics, I hear. So, it is directly linked to nutrition, poor growth and all of those health-related issues that are so essential to prevent further disabling conditions. Therefore, a disability that is a mild impairment can become a very severe disability if that prevention is not acted on. I had very great success—and this is a very long time ago now—in fitting very basic hearing aids to children who had otitis media, who were able to stay in school at a relatively low cost.

Chair

Is the provision of hearing aids a health or disability issue? I can understand that disabled people may take the view that there is a competition for resources and, therefore, the worry is that it will go on prevention rather than dealing with the problem they have. I understand that separation but, as you say, the crossover point is a bit unclear, and as I have already declared a particular interest in deafness, what are we doing about supporting deaf and, indeed, blind people with AIDS and other forms of disability?

Dr Miles

It is a highly complex topic, but I have to remember a discussion I had with the health director in Swaziland at the time, who said, “We cannot afford false teeth; we cannot possibly afford hearing aids,” which I thought was fair enough at the time in terms of spending. You have to prioritise. We managed to set up very efficient audiological clinics with second-hand hearing aids from this country—this was in the 1980s. But these things take a great deal of sustainable action; to fit and maintain the hearing aid is a very long process.

Chair

It brought down the cost a lot?

Dr Miles

Yes exactly. For me, a very mild hearing impairment, which can get very much more severe as children become older if it is not treated, is a much, much bigger problem even than the smaller numbers with profound deafness and blind children. I do not want to dominate the discussion with that issue, but on a health issue there has to be a link to health and education.

Lorraine Wapling

There is an issue where you try to put prevention in the same strategy as empowerment and mainstream inclusion. When you try to communicate the strategy, you come up against some problems. If you put prevention into the same strategy as inclusive development, when you come to talk to people who do not quite get disability inclusion, they tend to focus on the impairment and that goes back to prevention. Prevention then becomes easier to do, so your strategy becomes dominated by stuff around prevention. It is not that it is not important; it is absolutely crucial, but you find it is much more difficult to communicate a disability inclusive development strategy if you have prevention in the same place. AusAID learned from that. It is difficult to communicate in one way about disability inclusion when you are also talking about how to fix impairment. It is a problem. It makes it easier if you separate it, but I absolutely agree that it is a conversation that has to happen in parallel to the conversation you are having about disability inclusion because, from an effectiveness point of view, the more you can prevent, the better it is going to be. You want to have fewer disabled people, no doubt. It is also about making sure that rehabilitation services are available. That is definitely true. For me, that is a conversation that has to happen within the health sector. The health sector is huge. It has a much wider set of stakeholders. It can engage with many different people. Disability is very small in terms of the influence and the stakeholders who are involved at the moment. If you want to be able to be effective and efficient with things like prevention and rehabilitation, the health sector is much better placed to be able to help you with that discussion and to be able to implement it. It becomes a little more complicated around children and education. That is the point for me where the rehabilitation and health issues intersect significantly. From an adult perspective of the rehabilitation services available, taking a very bare necessity approach to it, if you want to make the most impact, go with children and think about how rehabilitation services affect their education potential. At that point, you really need to look at trying to bring the sectors together—health, nutrition and even social protection, come together and intersect with children and how they experience education.

Mr McCann

I stress that by asking this question I am playing devil’s advocate, but some people say that there is not enough data to show that disability-inclusive development is value for money. Our own Government has stressed from day one, since May 2010, that they will follow every pound and that the taxpayer in Britain has to have value for money. How do you respond to any suggestion that disability-inclusive development has value for money?

Bob McMullan

I guess I am the one who first had to deal with this issue with a different finance department in a different country, so I understand the question. It depends what you are trying to measure. At the most basic, is it true that there is not enough data? Yes, it is. It goes back to the question from one of your colleagues; there is not enough data, but we are getting more and more. “Value for money” is an easy phrase but it is a complex question. If you are saying, “For the dollar, are we having an impact on the lives of people?” the value-for-money argument is pretty easy to make with regard to disability. The interaction becomes more complex when you talk about its relationship with economic development. It is not that there is no relationship; if a person who previously could not participate in the workforce now can, that clearly has an economic development linkage that is straightforward. However, the measurement is more difficult. If your value for money is saying we want our pound—or in Australia’s case, our dollar—to change the lives of the poorest people, then the evidence, although we would still like more, is still clear that dollar for dollar, pound for pound, this is very effective. The economic interaction is there but at this stage it is more complex and harder to validate and compare it with some other form of expending your money for economic development. In terms of improving the lives of the poorest people, this is the value for money number one.

Dr Miles

From an education point of view, I can think of many very rich examples of improved teaching and learning in schools in Manchester, as well as in Uganda and other places, where those are focused on diversity and inclusion, and it is done very well. It has raised standards and expectations of all children. It has brought a greater skill set to those teachers. I have heard teachers say, “We are better teachers now. Even if you take our money away tomorrow”—this is Lesotho—“we will continue to be inclusive teachers, because we are better teachers and we did not know what we were doing before.” There is the ability to see children as individuals and ability to be flexible and responsive to children, so I see this issue as bringing added value to education and not necessarily costing more—arguably saving money.

Lorraine Wapling

I agree with my colleagues. Also, the issue to remember is that where you have a disability, it affects the individual, but it also affects the household. It is not just the individual that you are benefiting, but also the household connected to that individual. There is doubt about that. Where you have a household with an individual with a disability, the household is disadvantaged. That also disadvantages the community. I was involved in a very small-scale project in Malawi where they were trying to increase the economic potential of disabled people in the area. They did it through very cost-effective ways. It was about empowering disabled people themselves and giving disabled people the confidence to be economically productive and challenge some of the attitudes. It was a very well-designed project. I did an evaluation and I met with some community leaders. One community leader, completely spontaneously, said to me, “It has made a huge difference. Now that disabled people are benefiting our community, the whole community has come out of poverty. Because we are now including disabled people, the whole community has now improved and our economic prospects are much better.” Then she started reflecting on why that was the case, and she said, “Before, they were dependent; they were drawing our resources. Now they are productive, it means the whole community has a better potential.” That, for me, represents what we mean by value for money. It is not just the individuals that we are impacting on; it is their household and their community. If we want to work very seriously on reducing or eliminating poverty, then focusing on disability makes absolute sense, because it does give you—as Bob says—really good value for money.

Mr McCann

For all of your answers, you had me at “hello”; no convincing was necessary for me on that. DFID told us in their written evidence that it is very difficult to invest in large-scale projects until they have more data. They also tell us that they intend to improve their evidence base to get that data. Do you think that, even with a lack of data, it precludes an investment in a large-scale project and do you think there is a danger that, if we just wait until the data is available, we will lose opportunities to improve the conditions for disabled people across the developing world? Susie, you have a smile on your face.

Dr Miles

Well, I have “Doctor” in front of my name; I am supposed to know about data, aren’t I? I heard that there is a data session that Nora Groce is going to be speaking to, so I had not prepared to speak about data. I have a particular view on this. We have sufficient data to do what needs to be done; it is about a lack of will to do it. That is my feeling. I wrote a paper more than 20 years ago about the use and abuse of surveys and successfully persuaded UNICEF not to conduct yet another survey in Lesotho as it happened and instead directed it into a feasibility study of 300 schools to look at how feasible it was to promote inclusive education in the mountains. Therefore, it was directly impacting on the service provision and not separate from that. I was involved in a survey in Iraq on disability a couple of years ago, which was funded by UNICEF. It cost a large amount of money but nothing really has happened as a result. I am rather a sceptic when it comes to data. Either there is a will and we can scratch together sufficient quantities of data to be convincing that there is an urgency now and the moment is right in history, with the right agenda as well.

Lorraine Wapling

Yes, it is an excuse. There is enough data around. We know that it is a significant enough issue for now. If you go back 10 or 20 years maybe, yes, that was true, but now there is an increasing evidence base to say that disabled people experience development issues. Their experience tends to be much more negative. There is evidence out there. The other thing we need is for DFID to start to build up its own evidence base, and for that it needs to make a commitment. It needs to get started. It cannot continually keep saying that there is not enough evidence or “We do not know what is most effective.” They keep saying that without looking back and understanding what it, itself, is doing. It needs to begin to monitor itself to build up its own evidence base. It has to make the first step; then it can start to generate its own evidence base. That is what AusAID is doing right now.

Bob McMullan

You do not need to build any more data to establish that people with disability in developing countries are the poorest people in the world; we have already established that pretty clearly. Secondly, you do not need any more data to review all your current programmes and activities to make sure that they are disability-inclusive. You can do both those things now. If you were looking at targeting a specific programme on a specific issue, it may be that you need more data, but there is an enormous amount that you could start to do today. You might have seen the paper I distributed as a bit of a light-hearted presentation, but I hope you see the core of the point. It draws on a whole lot of United Nations data and other survey data to establish that the disadvantage is real and we know what it is already, whether it is education, violence against women, employment or political participation. In all those areas, people with disabilities are severely disadvantaged and there are tangible, concrete things we can do today. There is really no excuse not to be doing them.

Mr McCann

My final question is a bit of a moral conundrum; if it was put to a politician, they would be woolly and waffly and would not answer it. They would say, “We have to help everyone.” Let me put it to you: if you had £5 million to spend, and that £5 million could save 100,000 people from the ravages of AIDS, tuberculosis and malaria, but that same £5 million could help 1,000 disabled people, what decision would you make? Have you been in this situation in your professional lives, where those debates have taken place? What argument has triumphed?

Bob McMullan

In one sense, you put the decision-maker’s dilemma starkly. All resource-allocation choices are about confronting the awful reality that there are more worthwhile things to do than there is money and, when you choose to do A, you are, de facto, choosing not to do B. That will always be the case. In the UK and, in my experience, in Australia—although it might be a bit different now—our aid budgets were growing, so the choices were not quite so stark but they still exist. Resource-allocation decisions still have the implication that, “If I do twice as much A, I can do slightly less B,” and there is no perfect answer to that question. We are never going to put 100% of our resources into whatever we think the most important thing is; we have to spread it across the range of challenges. The case for a priority within that range of important issues for people with disabilities is the stark evidence that they are the most disadvantaged and they receive the least assistance, so that is a balance that needs to be redressed. You could not, though, redress it by saying, “We are going to give 100% of the money to deal with that and we are going to ignore AIDS,” because people are dying needlessly and we ought to be doing something about it. We will always have limited resources and have to make awful decisions about doing A and not B, or doing it in country A more than country B. There is no escaping that choice, and dealing with issues around disability is part of the same decision-making dilemma that every Government official and every Minister faces. I faced it, and colleagues here will be facing it. When the Government changes—it does not matter who they are—they will still face it.

Dr Miles

I am in an ivory tower. I am not a politician, thank goodness. I do not think there is an answer to that question, but I cannot help feeling there are disabled people who have AIDS and there are disabled people who get TB and malaria. Why is it always separated out? We have not talked about intersectionality. Disabled people are also girls and refugees; they also speak minority languages. They are poor. For me it is a nonsense, in a way, to separate it all out like that. I would want to prioritise people who are disabled and who also have AIDS and are vulnerable to TB and malaria within that programme, and mainstream it.

Lorraine Wapling

My perspective would be to say that you have to look at what is available globally and where the agency that has £5 million to spend can make an impact. If nobody else is looking at disability, then that focus on disability could be enormously influential, not just for those 1,000 people who you are investing in, but for showing the others who have done nothing on disability the impact that that can have. From an agency perspective, that might be very good not only for the 1,000 people who you are directly influencing, but you are also maybe able to influence others who had not even thought that this was an issue in the first place. You could then get more from your money than you were anticipating.

Fabian Hamilton

In targeting its programmes, DFID normally asks whether the programme will reach people who are socially excluded. We have had quite a discussion about this and I think, Dr Miles, you have made a very good point. The factors encompass a whole range of issues, such as gender, age, geography, ethnicity and vulnerability to disease, as you mentioned, as well as disability. Some NGOs recommend that DFID should target disability specifically. Dr Miles, you have made your views clear, but I wonder what the rest of the panel’s views are on this.

Bob McMullan

I think they do need to focus on disability specifically, not because I do not think some of those other questions of exclusion are unimportant. As Dr Miles said, they overlap. People with disabilities live in remote areas and have all sorts of other exclusion issues as well. There are two things that come together to make me say this is something we should target specifically. One is the data that shows that this is a particularly and extremely disadvantaged group; the second is that we know we can do something about it. That is a powerful combination of circumstances, and it would be sad to miss it.

Lorraine Wapling

I agree. For me, people have talked about social exclusion for a long time, and disabled people have not been included, so there is something that is still needed in order to persuade people who are working on social-exclusion or inclusion issues that disability is part of that debate. I remember, when I was in DFID, I did a little survey to do with the understanding of social exclusion. What came out was an issue that social exclusion tends to be seen in terms of political minorities or women; nobody talked about social exclusion in terms of disability, because people were thinking disability was linked to medical impairments. There is an issue to do with making sure that, if you are talking about social exclusion, you need to specify disability within that debate; otherwise, it does not come up automatically. That is one problem. The other thing is that disability is not just about social exclusion; it is about employment, health, HIV and gender-based violence. It is about all of those things, and there is a danger that, if you say disability is about social exclusion, you just put it to whoever is working on social-exclusion issues. If you are doing water and sanitation or health programmes, you do not think about it. It depends on how you use social exclusion as a sector and what social exclusion means within the agency. It tends to marginalise disability as an issue even more. You just have to be straight and to talk about disability-inclusive development. It is much simpler that way, because it then just means that, whatever sector you are working in, you have the mandate to talk about disability.

Fabian Hamilton

Susie, do you want to add anything to what you said previously? You have certainly made your views very clear.

Dr Miles

I think it has been said, really, but I suppose I would just reiterate that it is about issues of difference and discrimination. There is a danger of dealing with them all separately. As Lorraine says, the social-exclusion issues all intersect with disability, but disability tends to get forgotten and there is no doubt about that. The more that can be learned across the sectors within social exclusion, the better.

Fabian Hamilton

Let me flip this on its head. If we ensure that policies concentrate specifically on disability, how can we ensure that other discriminatory issues are not squeezed out—gay people, for example—with the issues you have raised about AIDS or vulnerability to disease and, of course, poverty itself? How do we ensure that that does not happen? Of course, the other issue is that older people too are, very often, completely marginalised.

Bob McMullan

We did not find that to be the challenge. DFID will have and AusAID had, and has in its new iteration, an overarching development strategy. It is just a question of whether you have specifically under it one focus on disability. It is very important but it is not the whole of our development strategy; it is just that, of the key five points that we are going to focus on, this, being the most disadvantaged group, is one of them. You have to do it. It is about disability-inclusive development. It is about development, and there are a whole lot of other issues. What those of us who are advocating on this issue are saying is that your development strategy has to have a conscious commitment to being disability-inclusive, but it does not obviate the fact that it is a development programme. Your colleague’s point that all allocation of resource apply choice is, of course, true but, within that limitation, it does not put other activities under threat. One can still support the Global Fund to Fight AIDS, Tuberculosis and Malaria, and do something about disability. Other than that there is a resource-allocation question, there is no contradiction.

Dr Miles

I suppose you are talking about competing agendas. At the grassroots, that is about money. I remember the example of a drought in Lesotho, when disabled people did not get fed because there was a programme dealing with them. When the food arrived at the village, they were not fed. That consciousness that is so simplistic is dangerous, whichever way it goes and whichever group wins out within the socially excluded groups. I suppose I would advocate for consciousness-raising about issues of discrimination and see it as an issue of discrimination, which has a lot in common with other aspects of discrimination in society. I differ slightly, maybe, from some of the other people on the panel on that.

Lorraine Wapling

I just think disability-inclusive development is easier language for people to get hold of. That is all.

Fiona Bruce

Good afternoon, panel. I have quite a number of questions on schools and school facilities. If you do not cover all your points with my first question, there are several more. DFID has recently committed to make the new school buildings it funds accessible to disabled children, but disabled children face less visible barriers to access. If DFID wants to ensure disabled children can access quality education, what should its next priorities be for those children in schools?

Dr Miles

I would say teacher education. It is fantastic that DFID has taken this stand on accessible buildings. It worries me that that is sometimes limited to physical access. Intellectual and sensory access is just as important: light quality, so that you can see the teacher’s face, is good for all children, painting the walls white, lowering the blackboards and making the windows bigger. There are all sorts of ways in which access can be seen more broadly, but it is about the quality of teaching and learning. That is a crisis anyway, from your 250 million children who cannot read, write or count after four years. There is a problem with the quality of education. In the work I did in Lesotho, we found 17% of children in those 350 schools in that feasibility study had some difficulty in learning, so there is a great deal to be gained, I would say, from drawing all teachers’ attention to the issue of disability and difficulty in learning, however you want to describe that—in this country, it is SEN—and that this affects maybe one-fifth of the school population and that it changes from time to time. Teachers need to see children as individuals, and that is about teacher education, not only at the pre-service level. It was done in Botswana in the early 1980s but it did not really have an impact. It has to be in service as well. There has to be ongoing teacher development. It is a range of interventions for teachers, I would say. We expect a lot of teachers in this term “inclusive education”.

Fiona Bruce

Mr McMullan or Ms Wapling, do you want to add to that at all?

Lorraine Wapling

I would just like to add that one thing that DFID could also do is make it a condition of its partners: not only does its direct spending on education need to be accessible, but where it is funding others—its partners—it should make it a general condition. Whenever DFID is contributing to infrastructure in particular, that should be included. The other thing is that, if you want to take it a step forward, you need to disaggregate data by disability. We need to know who those disabled children are in the school and we need to add that to the quality-assurance process, so that we know where disabled children are in terms of the system.

Bob McMullan

There is a lot, but let me just add one. It is usually the least attractive proposition. Making schools disability-friendly does not just mean you can get in; it has to mean you can go to the toilet as well. People do not like talking about toilets, but it is fundamental to the capacity of students to be able to participate in a school. That is an immediate second thing they need to do.

Fiona Bruce

My next question was going to be what resources DFID should set aside to take these steps. If you want to comment on that, please do so, but it is possibly fairly evident. Moving on, DFID is making increasing use of conditional bursaries and payment by results to improve school attendance and outcomes generally, but is there a risk that these frameworks exclude disabled children who may have more difficulty with regular attendance? You are nodding, Ms Wapling.

Lorraine Wapling

Unless we come down to looking at disaggregated data, there is a real danger that DFID goes into this results-based funding and could make the situation worse for disabled children, because it is going to be more difficult for disabled children to meet those requirements. Then schools are going to turn them away, so this needs to be introduced with extreme caution. The only way to do that is to monitor by looking specifically at what is happening to disabled children.

Dr Miles

It is about standards versus inclusion; that is how I would summarise this. Thinking about the UK context, we found it helpful to separate presence, as in access—getting through the door—from participation. The aim is to achieve your potential, which may not be the same as other children, so the idea of standardised testing and learning metrics is problematic with particular children with particular impairments. On the other hand, in this country, there has been a great deal of emphasis on academic results and there has been a raising of expectations for children for whom there might have been very low expectations. I suppose that what I would identify is some sort of differentiation of that payment-by-results policy, some acknowledgement that it is about achieving potential and raising expectations, but not necessarily achieving the same as everybody else. Does that make sense?

Fiona Bruce

Yes.

Bob McMullan

I agree fundamentally with what Lorraine said. If you treat people who are inherently unequal equally, it is as unfair as treating people who are inherently equal unequally. It achieves the same inequitable result.

Fiona Bruce

That is a very pertinent way of putting it.

Bob McMullan

It is not original.

Fiona Bruce

Dr Miles, you mentioned inclusivity. Could the panel comment on what you see as the main advantages and risks of inclusive education for disabled children in low-income countries as opposed to separation into special schools?

Dr Miles

There is an awful lot to say about that. I would start by saying that it is not necessarily about whether a child attends a mainstream school or a special school in a low-income country; it is either going to school or not going to school. I can tell you that Lorraine and I have worked together on a report about schools in Uganda, where the national average for deaf children is 2%: 2% of deaf children are in schools. That includes the special schools and the units. As a result of the National Deaf Children’s Society’s international support to parents and sign-language training, 8% of deaf children now go to school in a particular part of Uganda called Bushenyi. This was a very particular effort to increase that, but still only 8% are attending, so I do not think it is helpful to go back to the special-versus-inclusive debate that we have in this country, which is built on a very different history than many low-income countries have. I was in Samoa just a few months ago too, and the history of this field in Samoa is so utterly different from our own history. There is a very big danger in looking to western solutions, and special education and special schools, and assuming that is an appropriate response.

Lorraine Wapling

In this debate, it is not black and white; it is not one thing or the other. You have to go with what works. Above all, what we need to do is to research and find out more. The real issue for me is that, at the moment, neither system is working. We have, supposedly, special education happening in countries, but I just did a little bit of research and the reality that we found in Tanzania was that special schools were no different to mainstream schools in terms of what they were providing. The children were no better off in a special school. Even though they had made an effort to get there, there were no resources that were specific to their impairments. Whether or not the teacher turned up was fairly random. At the moment, the entire system is broken, so what is really important is that somebody makes a commitment to saying, “Education for disabled children is important,” and then, “Let us look at what is going to be the most effective in this context,” drawing on examples from other countries where they have made efforts, like Samoa, Uganda and Zambia. There are examples in all kinds of places, but let us try to look at something that is more strategic and that we think, over the longer term, might make a bigger difference. Do not, however, hold yourself to one model or another. It is about the child and about making the commitment to educating that child.

Fiona Bruce

Do you have any examples of what has particularly proven to work in resource-poor settings?

Lorraine Wapling

Susie mentioned the example of Uganda before, which is something that we often talk about, because that was a very resource-poor area. We were dealing with a specific group of children—deaf children—who are notoriously difficult to provide quality education for. The community made a commitment to wanting to ensure that their deaf children were educated locally in the mainstream school. Awareness-raising happened with the community so that they came to value the idea of education for their deaf children. In the past, there had just been an assumption that there was no point in sending deaf children to school. There was awareness-raising with the community and with the schools that were receiving the children. They then set up units attached to mainstream schools. It was not mainstreaming, and they were segregated. They were educated in a unit, but the children in the units where it was very successful were absolutely delighted. They were very articulate and very intelligent. Their language was really well developed, because they had the opportunity to interact with each other and other sign-language users, and the teaching improved as a result. There was integration going on in terms of the community, because the whole project took a community-based approach to education. It involved the whole community, so there was integration happening beyond the school itself. That was a fantastic example. There were problems and it was not exactly perfect. The other thing is that the local government took ownership, so local government was paying for the teachers in the units. That was another aspect. There was local-government ownership. Local government took the education of these deaf children as being a priority education issue, and they found some resources to enable at least the teachers to be paid, which made a big difference. It was small scale and there were virtually no resources except for the people, but it worked.

Fiona Bruce

That is very helpful. Do either of the other panel members want to give examples of good practice?

Bob McMullan

I want to add something that is consistent with this, which is that, in countries with very poor resources, you have to build on what there is. I do not want to give too many details, because my memory might be slightly wrong, but one of the small Pacific island countries had a specific school for visually impaired children. It is arguable that, if you started it afresh, you would not have done that, but it exists. The easiest way to improve outcomes is to improve that school. Starting afresh, you might not build that school, but it is there and it is there operating at a moderately good level, so the best thing to do is to make it better. In a different place, the solution would be different because what exists is different. The Samoan example is different. The children with a hearing impairment operate, essentially, in a class in an existing school. That is what you build on because it is there and the Government has made the resources and they can strengthen it. I think the most important point is the one that was made about not just importing our western debate as to what happens in our system into entirely different contexts.

Dr Miles

Can I just make one more point? It is something about which I have learned a lot from doing research in this country as well as in other parts of the world, and it draws on experience in Lesotho. It is the issue of a whole-school approach. I know that the example that Lorraine and I have just given was of deaf children in a unit that was, essentially, separate, and there are arguments why, sometimes, it is helpful to have deaf children slightly separate but included. The danger of importing the idea of a special educational needs co-ordinator, for example, which some countries have done—I think they have done it in Uganda—and making one person a specialist within a mainstream school is that all the problem children whom nobody wants to teach end up being educated by that specialist. In Lesotho, there was an insistence from the beginning that every teacher in all 10 pilot schools was trained in what inclusive education is. Health professionals, special-schoolteachers and disabled people’s organisation representatives were involved in the training—everybody who had any stake in disability got involved. It was seen as a whole-school issue and not something separate and special.

Fiona Bruce

I appreciate that what you are saying is that some provision is better than no provision, but how would you respond to the argument that some people make that, in class sizes of over 80, it is not realistic to teach children with sensory disabilities in mainstream schools?

Dr Miles

There were well over 100 in these classes in Lesotho 20 years ago, and they were the most positive of teachers in that whole programme. We had a meeting many years ago about inclusive education, and there was a unanimous agreement that class size was not necessarily a barrier. It does not mean that we would promote large class sizes as a good thing, but there were lots and lots of examples from practising teachers who are used to managing large classes. When given a little bit of knowledge and guidance on how to teach more inclusively, they did not see large classes as necessarily the big issue. What we tend to forget with our class sizes of 30—if you are lucky—here is that children are a tremendous resource. We overlook children as a resource in schools. Where you have large class sizes—and I know that this is looking on the bright side and that there are problems—children can play a very big role in promoting inclusion through buddy systems, literally walking or pushing children to school and making notes. There are many examples I could think of where children have played an active role in promoting inclusion.

Fiona Bruce

A final question is on schoolchildren: disabled children can be vulnerable to bullying. Do you think that this, perhaps in mainstream schools, may discourage them from attending in a way that special schools could help prevent? Again, we are talking about an ideal world here, and I would ask that question.

Dr Miles

Bullying is an issue for schools in all sorts of ways, not just about disability. Engaging the whole school and all children in the project that is disability-inclusion is a bullying-prevention strategy. I concede the fact that it does happen—children can be cruel; teachers can be incredibly cruel—but, where there is strong commitment, conviction and awareness of discrimination and the damage that it does, and a buy-in, in a sense, to inclusion, that need not be the case. Friendship does need fostering. Your colleagues mentioned that in one of the earlier questions: it is no good going to school if you have no friends. Everybody has a responsibility in making that happen, because it does not necessarily happen naturally.

Lorraine Wapling

I can just add very quickly to that. Again, a little bit of research that we did specifically asked disabled children about their experiences of bullying, and there were lots of experiences of bullying from both special schools and mainstream schools. There is an issue, a lot of which has to do with teachers not being aware of what is happening and seemingly condoning the bullying that is happening. One of the issues is definitely about making sure that there is an awareness of bullying among teachers and that they can deal with it. One thing that continues to really concern me is about special schools and who is monitoring what happens in special schools. I get very concerned about the lack of governance and monitoring of behaviour and what happens in special schools, particularly to do with vulnerability and sexual and physical abuse. Because a lot of special schools are outside the mainstream system, there is very little accountability and oversight of who is employed. Basically, special schools are really outside the mainstream, and I get really scared about knowing what is really happening, especially where they are boarding. Who is really overseeing what is happening in these special schools? That really frightens me.

Fiona Bruce

One final question on a different topic: multilateral agencies. Much of DFID’s budget is spent through multilaterals. Have you formed a view of how successfully key multilaterals include disabled people in their work, and how could DFID best encourage them to give disability a higher profile? Should this, perhaps, be a condition of funding, which Ms Wapling mentioned a short time ago?

Bob McMullan

DFID really has a critical role to play. They are a major funder of many of these international UN agencies and international financial institutions. Some of them try but, in my view, none of them have really got the disability-inclusive message comprehensively yet. Some of them have had terrific disability advisers. I was dealing with it more directly with a very good person at the World Bank, who was doing good work. I am not saying that nothing is happening; that would be totally unfair. However, I do not think that, comprehensively, any of the agencies, when I dealt with them—and I am two or three years out of date with this—had what I thought was a comprehensive view about disability-inclusive development. There were a couple of exceptions, and UNICEF was the closest. A big role for DFID is advocacy generally in the UN system—someone mentioned earlier post 2015; not just that but that most immediately—and in international financial institutions and other bilateral agencies. Someone also mentioned what they do through the Disability Rights Fund. That combination of things is a very important aspect of where DFID, because of its scale, could be very significant.

Dr Miles

Can I just link that to a point that Lorraine was making? Maybe we need to re-emphasise that, and I do not know whether the multilaterals, through DFID’s influence, could influence this. Disabled children do tend to be managed by social-welfare ministries and other names as such, and are not seen as part of education. That was the case in this country: children with intellectual impairments were under Health until 1970, and it was only when all disabled children’s education was seen as the responsibility of the Ministry of Education that things really changed. That sounds a small thing, but it is a major institutional and organisational issue that could, through some of these agencies’ influence, bring about a very big change in how disability is seen, in educational terms anyway. I will leave that question to Lorraine.

Lorraine Wapling

When I was doing my interviews for the AusAID review, I was in contact with the multilateral partners that had specifically a disability element to their partnership. All of them said how much they appreciated that focus from AusAID, because—it is the same argument—it gave them the opportunity to push the information with their own agency. If someone as big as DFID says, “You have to have something linked to disability, you have to report on it and it has to be reportable,” so it has to be something that they are held accountable to, you put that in and they have to do something about it. There are people within these agencies who are desperate for those kinds of conditions to be added, because it would enable them to work within their own agencies to improve things. I have requests saying, “If there could be more conditionality linked with disability, we would be really happy.”

Dr Miles

Can I just say one more thing? It is 20 years since Salamanca this year. Salamanca was the big moment internationally, where inclusive education was announced as the way forward through UNESCO. At that time, there was a disability champion in UNESCO, which is not the case anymore. There are people in UNICEF who are disability champions, and great things are happening, but there is a great danger that it is not institutionalised or established. This is a great opportunity today to contribute to that.

Chair

Thank you very much indeed. It has been a long but useful session. Both panels have given us a lot of insight and a lot to think of on the first time that we engaged on this. What I would say to you is that, if you have any reflections after this—anything you can add or reinforce—or any additional information that you want to draw to our attention, please do so, because we are really at the start of this process. We take the point that we want DFID to do better—I think they have said they want to, but we have to help them to do it—and, through DFID, to ensure that they encourage others to do so. It is also good to hear that we can learn from other development agencies, like the Australian one. I hope that, whatever else happens with AusAID, as was, it does not abandon what it has achieved. It is always a shame that, when there is a change of Government, some good initiatives disappear.

Bob McMullan

I am sure it will not. The Prime Minister has made some very strong speeches about disability, and my understanding is they are going to move to a new strategy, so I am quite optimistic. Thank you very much, Chair.

Chair

That is good to hear and, hopefully, the UK and Australia can continue to work together on these issues. Thank you all very much. Oral evidence: Disability and Development, HC 947 2