London School of Hygiene & Tropical Medicine

The London School of Hygiene & Tropical Medicine (LSHTM) is to lead a major new project that aims to reveal which interventions should be implemented to improve the well-being of people with disabilities in low and middle-income countries (LMIC).

Despite millions of people escaping poverty over the last 20 years, the global situation and wellbeing of the majority of people with disabilities has not sufficiently improved. Running over five years the £7m project, Penda (meaning love in Swahili), funded by the Department for International Development (DFID), will evaluate interventions so policymakers can make evidence-based decisions on issues including poverty, health, education, stigma and discrimination.

Disability Inclusive Development (DID) is about providing services, such as health and education, which meet the needs of all children and adults. It means ensuring that the additional costs of disability are met and that disabled people have a chance to flourish on an equal basis with others.

There are an estimated one billion people with disabilities globally – approximately 15% of the world’s population. An estimated 80% of people with disabilities live in LMICs and one in five of the world’s poorest people have a disability. This number is likely to increase in the future as population’s age and chronic conditions that lead to impairment and disability become more prevalent.

In LMICs, people with disabilities and their families are poorer than people without disabilities in nearly all socio-economic indicators. They are more likely to remain poor due to higher living costs, unpaid caring responsibilities, exclusion from education and employment, and entrenched stigma and discrimination.

The project will be led by Professor Hannah Kuper and Professor Tom Shakespeare, with support from the International Centre for Evidence in Disability (ICED).

Professor Shakespeare said: “At the moment we lack evidence of what works to remove barriers and achieve inclusion for disabled people in developing countries.  The Penda programme of research seeks to fill some of these gaps with good quality evidence. 

“The evidence we generate will show what interventions are worth supporting, thus helping improve lives.”

The research team have identified three key themes for exploration:

• Knowledge - there are major knowledge gaps around what works in DID and so researchers will aim to discover how DID can improve education, health, livelihoods and in reducing stigma.
• People - many people investigating DID are mostly from high-income settings and so rarely have the lived experience of disability in LMICs. This programme will improve the capacity of researchers from LMICs to conduct research on disability, in particular researchers with disabilities.
• Tools – better tools will be developed in the programme to measure effectiveness of DID and how to measure impairment.

The grant will fund ten new research projects – six of which will be led by LSHTM.

Penda brings together partners including Help Age International, Action on Disability and Development, and the overseas disability charity CBM. Researchers will also work closely with wider organisations that support disabled people.

Professor Kuper said: “Today’s world is often not built for people with disabilities and disabled people around the world often face really negative attitudes. 

“The findings of our research could really make a difference in ensuring that people with disabilities are not left behind.

“I am delighted that we will be working closely with a range of fantastic partners, and people with disabilities, in this project. This will help us to do the best possible research, on the right questions, and make sure that the findings are used to improve policy and programmes.”

The first research project, DEWORM-3, is already under way looking at the inclusion of children with disabilities in Mass Drug Administration.  

DEWORM-3 is a Gates-funded initiative looking at whether giving children medication through school or through the community is more effective.  As well as seeing what the difference is for disabled participants, we will take the opportunity of exploring with children, parents and teachers what some of the barriers are to inclusive education in Malawi and India.