Is policy helping people with disabilities to access sanitation?

In this third part of Water, Sanitation and Hygiene (Wash) and disabilities, University of Malawi’s Centre for Social Research (CSR) researcher JOSEPH CHUNGA looks at the dynamics of the interplay between research finds, policy and practice in an attempt to show how the three interact to improve people with disabilities access to Wash.

The Sustainable Development Goals aim to achieve universal access to improved Water, Sanitation and Hygiene (Wash) by 2030.  In order to achieve this, we need to give particular attention to segments of the population, such as people with disabilities, whose Wash needs are not being sufficiently met by current programming. 

Malawi is recognised to have strong policies in relation to disability inclusion. This is reflected in policies and national guidelines related to Water, Sanitation and Hygiene (Wash). However, as in many counties, there are challenges in translating these good policies into tangible benefits for people with disabilities at the community level.

This research aimed to explore and understand the gaps between good policy and practice. This report summarises the findings generated through 50 interviews with stakeholders within the Wash or disability sectors as well as 36 interviews with people with disability and 15 interviews with carers of people with disability.

This report provides a historical chronology of key policy decisions. From this chronology it becomes clear that there has been a fundamental change in the way disability is understood within Malawi—namely a progression from a medicalised understanding of disability to the now dominant social model of disability.

Although policy documents reflect this shift there is evidence to suggest that actors within the sector feel that the move towards the social model of disability was largely due to external international trends and they remain unconvinced of the appropriateness of the social model to a context where some basic services for people with disability are still lacking. At a community level there is also still a discrepancy in the way disability is understood.

Commonly, people with disability are still viewed with pity and expect direct assistance from the government. Inconsistencies between the intent behind policy documents and the dominant view of disability within Malawian communities, may be one reason expectations are not being fully met currently.

Stakeholders felt that policy making was still the remit of just a handful of people at the central government level and that more could be done to make it more participatory. Although people with disabilities support policy making within the disability sector they are still not consulted on policy-making within other sectors (e.g. the Wash sector). Policy dissemination remains limited, with many low level government staff being unaware of policies that ought to govern their work.

One of the major policy gaps identified was the process of incorporating national policies into district planning. Currently the majority of external funds to support governance and policy are channelled at a National Government level. Allocating some of these resources to the districts could be one way forward.

Core policy strategies within the Washand disability sectors were identified and explored to understand whether modifications to these could lead to a better translation of policy into practice. The Department of Disability and Elderly Affairs has championed the mainstreaming of disability issues into all government and non-government programme.

In practice this has been difficult to realise due to limitations in funds, slow progress on establishing plans or monitoring mechanisms and a lack of specific guidance on what mainstreaming actually looks like. At lower levels the absence of funds for mainstreaming and the lack of direction has become an excuse for inaction.

Malawi is also strengthening its Community-based Rehabilitation (CBR) programme which currently operates in half of the country’s districts. CBR programs are well positioned to connect people with disabilities to services in their communities but actors identified that CBR workers do not currently ask about the Wash needs of people with disabilities, nor are they aware of locally available services.

This was identified as a missed opportunity. Within the WASH sector there are two dominant sanitation demand programs—Community-led Total Sanitation (CLTS) and Sanitation Marketing.

To date, both of these programmes have not specifically addressed the needs of people with disabilities. Coming up with specific steps to make these programmes inclusive would likely have a positive effect in raising community awareness of different Wash needs and would create a demand for innovative Wash facilities among people with disabilities.

This research explored whether financial limitations and human resources also effected the translation of policy into practice. The research found that in a context where all government sectors are low on funds, it will remain a challenge to prioritise this issue, which although incredibly important to those it effects, is only an issue for a small percentage of the Malawian population.

Despite there being strong capacity at a district level to make context-specific planning decisions, these are almost always undermined by irregular disbursements from central level government and the heavy reliance on donors and non-government actors to financially support initiatives at a local level.

This commonly results in the prioritisation of funding to maintain critical government assets (rather than service delivery) and programs which are in the interest of donors. There is also a perception that the fiscal processes of both Government and non-government actors are not sufficiently transparent. Staff shortages and associated delays in government recruitment processes also create significant challenges for quality service delivery at the district and community levels.

This research mapped the stakeholders who are currently doing work in the Wash, disability or general community development sectors. Through interviews with these actors, they outlined their current role and outlined the constraints and enabling factors that may affect their ability to take action on making Wash more inclusive for people with disabilities.

By mapping their current levels of influence and position in relation to this issue we found that prioritisation of Wash access largely rests with international donors and United Nations (UN) agencies due to their financial influence and agenda setting role. There is evidence that there is increasing ownership of the issue within certain government departments and within NGOs.

However more could be done to engage people with disabilities, village leaders, religious leaders and masons in order to make Wash access informed by the actual opinions of people with disability and sustained and supported at a local level.

Lastly this research this research tried to understand what is currently being done by government and non-government actors to improve Wash access for people with disabilities. This was explored in contrast to the ideas of people with disabilities and their carers about how they could best be supported. The research found that the majority of work is currently channelled into developing adaptive technologies or improving infrastructure in public facilities (primarily at schools).

In fact, people with disabilities felt that it would be more useful to improve facilities at a household level first as these are used most frequently and therefore have the biggest impact on health, dignity and self-esteem. People with disabilities and their carers also cited a range of other potential solutions that are currently not being addressed by the sector.

Broadly speaking, these include more inclusive Wash programming, community support structures, specialised Wash initiatives, and medical interventions for home-based care. Current barriers to effective programming include the predominance of quantitative reporting on Wash access and the tendency to describe practice through ambiguous buzz words (e.g. sensitisation, empowerment, etc.).

Implementers recognised that it would be useful for them to move away from developing standards for infrastructure and instead develop step- by-step guidelines for how to make all Wash programming more inclusive. Establishment of sector-wide indicators which more effectively measure Wash use by people with disabilities (including qualitative assessments), would also be a positive step.

The issue of improving Wash access for people with disabilities has unfortunately been slow to come to the fore in international development. The wording of the SDGs provides a useful incentive for us to accelerate work in this area.

Malawi has taken many positive steps to improving Wash for people with disabilities. n