According to the United Nations Development Programme, four to six percent of the world’s population is disabled. The prevalence of disability in many developing countries is exacerbated by poor nutrition, disease, conflict and accidents due to poor regulation. Many disabled people face numerous physical and attitudinal barriers, which contribute to their isolation and impoverishment. If development is the expansion of (and removal of barriers to) the freedoms that people enjoy, a key aspect for disabled people is improving their access to the physical environment.

The United Nations ‘Standard Rules on the Equalisation of Opportunities for Persons with Disabilities’ (1993) has been adopted by most countries but issues of access are still largely ignored by planners and development practitioners. The UN rules aim to secure government commitment to granting equal rights and opportunities to people with disabilities. Accessibility is a key target area for guaranteeing equal participation: changes in the physical environment would enable people with disabilities to enter public buildings, use public transport and facilities, move about in their homes and communities with ease, have access to information, and know what services are available to them. This issue of id21 insights focuses on these matters, particularly with reference to people with physical (mobility) and visual impairments.

Why access?

Improving access to the physical environment results in greater social equity: it enables disabled people to participate in social, economic and religious activities on the same level as non-disabled people, resulting in a more inclusive society. Dismantling barriers reduces disabled people’s vulnerability and dependence on others. In Ethiopia, Tamru Belay writes about how computer training has enhanced blind Ethiopians’ employability and capacities to pursue further education. The training programme’s success has also raised the government’s awareness of their potential and rights, and is a powerful advocacy tool.

Access for all

A common misconception is that adapting or building accessible environments is a costly exercise. Conventional design is aimed at non-disabled people and accordingly fails to provide for many potential users’ needs. Universal design principles, by contrast, aim to accommodate as wide a range of potential users as possible, including, but not exclusively, people with disabilities. North Carolina State University in the USA defines universal design as the design of products, communications and environments which can be used by everyone, to the greatest extent possible, without the need for adaptation or specialised design. Dave Maunder and Jo Sentinella highlight results from their research on disabled access to transportation services, in which they found this principle to be an essential aspect of successful projects.

Similarly, research in Uganda by the Water, Engineering and Development Centre  and in Sri Lanka by the Intermediate Technology Development Group (ITDG), on building accessible toilets demonstrates that designs based on universal principles need not be costly and can be adopted and constructed by local communities, with little or no outside assistance. Hazel Jones and Bob Reed, looking at water and sanitation infrastructure for poor people in Cambodia, Uganda and Bangladesh, point out that services designed for disabled users are beneficial for other members of society, including elderly and sick people, and mothers with young children.

Ensuring access

It is important to note, however, that solutions are about more than just design and building codes. First and foremost, approaches should be centred on what disabled people themselves say they need and how best to achieve it. Enabling environments that encourage the involvement of users and ensure their views are heard are therefore a primary consideration.

ITDG’s experience in Sri Lanka emphasises the importance of a community planning process that actively seeks to put disabled people at the centre of development objectives to ensure their needs are met. Handicap International in Viet Nam worked with the Youth Disabled Association on an accessibility campaign, in which disabled young people demonstrated to public building managers and the public that they can, and are, actively involved in promoting measures to help them live independently.

A word of caution

Disability is becoming recognised as a development area with special needs. Numerous disability-focused movements are gaining visibility. However, the way forward needs to be carefully thought out. Considering that most disabled people in developing countries are the very poorest, planners must also ask: access to what and for whom? Rebecca Yeo provides a cautionary tale from post-Tsunami Sri Lanka, where, despite the rhetoric of disabled access, the reality might mean that not only disabled people but other poor people as well, may be cut off from their former livelihoods as reconstruction favours business interests.

The term ‘disability’ masks a wide range of types and experiences: disabled children, women and the elderly are doubly or even triply disadvantaged. The case study on disabled women’s experiences based on research by Hazel Jones and Bob Reed emphasises that any consideration of disabled access must examine the particular needs of different groups.

More than just a medical issue

The International Classification of Functioning, Disability and Health (ICF) was developed by the World Health Organisation (WHO) in 2001 in collaboration with Disabled Peoples International, the European Disability Forum, Inclusion International as well as many individuals with disabilities. Intended for use in clinical settings, by health services or for surveys at the individual or wider community or national level, the ICF is an attempt to move away from the view that disability is simply a medical issue. It encourages health professionals and others working with disabled people to look beyond the health condition of an individual and consider other factors that may prevent or hinder them from participating in all aspects of life. The chart below shows this, using cerebral palsy as an example.

As the ICF illustrates, most disabilities are the result of a medical condition which effects ‘human functions or structure’ as well as a person’s ability to carry out ‘activities’; it follows that doing less will lead to reduced ‘participation’. Someone with severe rheumatoid arthritis, for example, is likely to have reduced mobility and be less able to participate in their chosen activities. Planning good access to buildings and public transport may help but unless ‘participation’ is also addressed, solving access to the activity is only part of the solution.

The ICF also recognises that ‘environmental’ factors such as having to live with the stigma of disability, limited educational opportunities or not being able to get on a bus - will affect people’s ‘activities’ and degree of ‘participation’. The ICF also includes ‘personal factors’ such as self confidence and security which will influence a disabled person’s coping strategies.

Using the ICF in planning access to facilities or services for people with disabilities will require professionals to take risks and move away from areas where they feel confident and safe; instead they need to consider the lifestyle of their clients and how rehabilitation (if appropriate and if requested by the client) can improve that person’s lifestyle. As this issue of id21insights discusses, architects, planners and builders will need to consider how disabled people can enter buildings and use transport or water and sanitation facilities, but they will also need to consider how they can take part in activities of their choice.

Building accessible environments

The opportunities for and constraints to improving access to both new and existing infrastructure will depend on the context in which improvements are undertaken, including availability of resources (human, physical, financial), culture, attitudes and laws regarding disabled people’s rights. There are likely to be significant differences in needs and therefore approaches among and within countries, between rural and urban areas, and between formal and informal developments. Anybody working with disabled people to achieve barrier-free environments should also remember that:

• Professionals should be ready to hand over decision-making to disabled people, who are in the best position to identify their own needs and concerns.
• Physical and technical interventions are only one part of a bigger picture that also requires paying attention to human rights and equal opportunities.
• Systematic reviews of the performance of projects, programmes and policies are necessary to ensure that good and bad practices are identified. It is as important to learn from mistakes as from successes and to share learning.
• International frameworks such as ICF and universal standards can be useful tools for implementation and research.

Source(s):
‘Breaking barriers: building access for disabled people’, May 2005, id21 insights #55 Full document.

id21 Research Highlight: 2 June 2005

Further Information:
Sheila Wirz
Centre for International Child Health
University College London Medical School
30 Guilford Street
London
WC1N 1EH
UK

Tel: +44 (0)207 242 9789
Contact the contributor: S.Wirz@ich.ucl.ac.uk

Centre for International Child Health, London

Sheilah Meikle
Development Planning Unit
University College London
9, Endsleigh Gardens
London WC1H OED
UK

Contact the contributor: ucfushe@ucl.ac.uk

Development Planning Unit, UCL, UK

Other related links:
‘Training Ethiopia's blind people in ICTs’

‘Taps and Toilets: accessible water supply and sanitation’

‘Women are disabled too’

‘Building bridges: creating disabled-friendly environments in Sri Lanka’

‘Get moving: better access to public transport’

‘Campaigning for access in Viet Nam’

‘After the Tsunami: are disabled people being ignored?’