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An estimated 15% of the world’s population experience some form of disability. Across Europe and Central Asia, persons with disabilities represent one of the largest segments of the population that are vulnerable and often socially excluded. In the region, individuals aged 16 and above report enduring limitations in their day-to-day activities due to health-related issues—ranging from 12% in Serbia to 37% in Latvia for long-standing limitations, while at least 3% regionally experiencing severe constraints. With most countries across Europe and Central Asia experiencing a rapidly aging population, this percentage is anticipated to rise as older individuals are more prone to developing disability.
Drawing from a wide array of projects and analytical work, a team of disability inclusion experts from across the World Bank aims to highlight instances where governments in Europe and Central Asia have provided support to persons with disabilities through social protection. By outlining technical and operational experiences from several countries including North Macedonia, Romania, and Uzbekistan, the team can provide valuable lessons learned for other governments in better designing and developing social protection systems to meet the needs of persons with disabilities and ensure more inclusive, resilient economic growth.
The team’s focus falls across five areas:
Modernizing Disability Assessment Systems
Establishing a system for assessing disability is crucial for accurately identifying an individual’s specific impairments and functional limitations as well as identifying the support and resources required for ensuring that the individual can lead an independent life within the community.
Defining Disability and the Role of ICF and CRPD
While some countries across Europe and Central Asia continue to rely on a solely medical assessment of disability—where disability is primarily viewed as a medical issue requiring medical or rehabilitative interventions—international approaches have shifted to a functioning model of disability assessment. Such a model recognizes the impact of environmental barriers on individuals and emphasizes the need for social inclusion.
The International Classification of Functioning, Disability, and Health (ICF) and the Convention on the Rights of Persons with Disabilities (CRPD) provide modern frameworks for disability assessment. The ICF focuses on a person’s functioning, considering body functions, activities and participation, and environmental factors. The CRPD defines disability as the interaction between impairment and environmental barriers offers a more comprehensive perspective. It promotes accessibility, non-discrimination, and equal opportunity for persons with disabilities, supporting the use of the ICF framework in assessments. Aligning assessment with the principles of the CRPD promotes inclusion and empowers persons with disabilities to lead independent lives.
Why is it Important to Modernize Disability Assessment?
Modernizing disability assessment is crucial as it serves as the gateway to accessing social benefits and services. By ensuring assessment procedures accurately capture an individual's functioning and limitations, tailored support packages can be provided to address their specific needs. Modernization also shifts the focus from the traditional medical model of disability to a functioning model, which recognizes the impact of environmental barriers and emphasizes social inclusion. Adopting such a framework is key for identifying the needs of persons with disabilities more accurately, which better ensures the well-being of the individual and other members of the household, who often dedicate time to care for loved ones with disabilities.
Many governments in the region are undergoing reforms to align their assessment systems with the CRPD, offering lessons learned on the adequacy of existing disability assessment systems as well as the steps involved in transitioning from a medical model of disability to one based on ICF.
Modernizing disability assessment systems involves three aspects:
(1) Disability Assessment System Analysis
A comprehensive analysis of the disability assessment system, based on the ICF, aims to improve policies and services for individuals with disabilities. The analysis explores various components of the system, including legislation, assessment processes, human resources, information systems, benefits and services, individual experiences, and institutional arrangements. By considering factors such as budget, time frame, national context, and available data, the analysis seeks to identify areas for improvement and generate recommendations for a more inclusive and efficient disability assessment system. The ultimate goal is to enhance the functioning of the disability system, promote inclusivity, and cater better to the needs of persons with disabilities. Key documents from Bulgaria, Latvia, Lithuania, and Romania provide valuable insights into their respective disability policies and assessment systems.
(2) Disability Assessment
By adopting a holistic approach that aligns with the ICF and CRPD, the goal is to accurately assess the impact of health conditions on individuals’ daily lives. The integration of the functioning model recognizes the importance of considering impairments and environmental factors, leading to a more comprehensive understanding of disability. The WHO’s WHODAS tool serves as a reliable means of evaluating functioning and has been implemented in various countries, including France, Italy, Canada, Cyprus, Argentina, Brazil, and Taiwan. Countries like Albania, Azerbaijan, Bulgaria, Latvia, Lithuania, North Macedonia, and Romania have sought technical support from the World Bank to improve their disability assessment systems and ensure fair and accurate assessments.
(3) Needs Assessment
While many countries require a certified disability status for accessing benefits and services, there is a growing recognition of the need for a more comprehensive needs assessment beyond determining disability status. Disability status assessment serves the function of categorizing individuals, while needs assessment quantifies individual needs and matches them with appropriate services. Needs assessment encompasses various aspects of an individual’s life affected by disability and involves a detailed and individualized process. The assessment instruments and tools used collect comprehensive information to address individuals’ specific needs and circumstances. A synchronized approach between disability status assessment and needs assessment is crucial to ensure coherence and consistency in the evaluation process. Key documents from Romania and Bulgaria highlight the focus on needs assessment and the piloting of disability assessment and needs assessment to strengthen the disability system.
World Bank Reports
Bulgaria Disability System and Policy: A Comprehensive Review
Bulgaria: Options for Including Functioning into Disability Status Assessment
Latvia Disability Policy and Disability Assessment System
Options for Including Functioning into Disability and Work Capacity Assessment in Latvia
Lithuania Disability Policy and Disability Assessment System
Options for Including Functioning into Disability and Work Capacity Assessment in Lithuania
Romania: Diagnosis of the Situation of Persons with Disabilities in Romania
Access to Social Benefits
It is crucial for governments to ensure that persons with disabilities have sufficient access to mainstream programs designed for the general population, such as pension or anti-poverty programs. Additionally, those with disabilities should have appropriate access to programs specifically addressing additional expenses associated with their disabilities.
Enhancing Access: Independent Living and Community-Based Services
The rights and inclusion of persons with disabilities play a crucial role in the advancement of society. Within these rights, independent living takes center stage, serving as a fundamental component of the United Nations Convention on the Rights of Persons with Disabilities (CRPD). Independent living empowers individuals to cultivate their personal identity and unlock their full potential. CRPD Article 19 recognizes the right of persons with disabilities to live independently and be included in the community, enabling them to exercise freedom of choice and control over their lives on an equal basis with others. Exercising this right entails access to various resources that provide persons with disabilities equal opportunities to live with dignity and autonomy, actively participating as citizens in society.
According to the CRPD Committee, independent living is linked to an individual’s autonomy and freedom and does not necessarily mean living alone or being able to carry out daily activities by oneself. Rather, it should be understood as the freedom to choose and control one’s life, on equal basis with others, with the needed support. Moreover, children possess the right to reside in a nurturing family environment as per the United Nations Convention on the Rights of the Child (CRC).
Understanding Institutional Living
To understand the significance of independent living, it is essential to recognize the adverse effects of institutional living. The European Expert Group on the Transition from Institutional to Community-based Care highlights that residential care institutions often breed depersonalization, limited autonomy, and isolation. Individuals residing in such settings are deprived of meaningful choices and control over their daily lives. The CRPD Committee highlights that even individual homes can be considered institutions if they show defining elements—such as lack of control over day-to-day decisions, lack of choice over whom to live with, and a paternalistic approach in service provision.
Moreover, institutionalization can have long-lasting detrimental impacts on a person’s physical and intellectual well-being. Research demonstrates that children who experience institutionalization often face delays in their physical, intellectual, and brain development. These conditions hinder their ability to thrive and impede their attention functioning.
Moving towards community-based services
Tragically, many individuals find themselves spending most of their lives confined within residential care institutions due to a lack of accessible alternatives. It is imperative for countries across Europe and Central Asia to find solutions that lead to the closure of all residential services and the development of individualized support in the community. Deinstitutionalization efforts should be inclusive and comprehensive, targeting all persons with disabilities, while also implementing measures to prevent any form of (re)institutionalization. According to the UN Committee on the Rights of the Child, children living in institutions should be supported to live in their family, extended family or foster care.
The benefits of community living
Contrary to popular misconceptions, community-based models of care are not inherently more costly than institutional settings. Research indicates that when comparing comparable needs of residents and levels of care quality, community living is not only cost-effective but also yields superior outcomes. The benefits of community living extend beyond financial considerations, as they encompass holistic well-being, social integration and contribution to society, and personal fulfillment.
When transitioning from institutional to family or community settings, individuals who have previously lived in institutions may encounter certain risks. However, it is important to note that the opportunities presented by this transition far outweigh the potential risks. Moving into a natural environment allows people to embrace a sense of normalcy, explore new and enriching experiences, unlock their potential, make independent decisions, and assume personal responsibilities. In this process, community support services play a crucial role in both preventing and mitigating any associated risks, ensuring a smooth and successful transition.
Enabling independent living through support services
Realizing independent living necessitates that governments provide persons with disabilities the necessary support to fully exercise this right. The UN Committee on the Rights of Persons with Disabilities offers detailed guidance on the scope of support required and the conceptual framework surrounding it. This support must encompass access to mainstream services tailored to meet a diverse range of needs, including employment, education, healthcare, housing, culture, and leisure. Additionally, specialized support services should be available to ensure continuity of person-centered care, driven by the individual’s preferences and choices.
Developing inclusive community-based services
Community-based support services hold the key to preventing isolation and segregation while ensuring inclusivity. These services must adhere to essential principles: universal accessibility, proximity to individuals’ homes, meeting quality standards, cultural and gender appropriateness, affordability for low-income individuals, and adaptability to meet the unique needs of each person. Community-based support services need to be strategically planned to allow for an organized approach to meeting diverse individual needs in the community, wide coverage, long-term sustainability, collaboration and coordination among various stakeholders for enhanced outcomes. Ensuring predictable financing of community-based support services promotes their development and diversification. It also promotes a system more able to prevent situations of vulnerability and risk rather than just react to them.
In conclusion, the adoption of independent living principles and the establishment of community-based services are key to unlocking the power of inclusion and empowering persons with disabilities to lead fulfilling lives. It is the responsibility of countries, as outlined in the legal framework of the CRPD, to dismantle barriers, promote equal opportunities, and create an inclusive society that nurtures the potential of every person, regardless of their abilities.
Promoting the Right to Work and Employment for Persons with Disabilities
The right to work is a fundamental right, recognized under Article 27 of the Convention on the Rights of Persons with Disabilities (CRPD). Persons with disabilities must have opportunities to use and enhance their qualifications and skills, have equal access to employment, and their workplaces should be adapted and inclusive. States that have ratified CRPD should provide various kinds of support to ensure that any person with disabilities who wants to work can find quality employment.
The UN Committee on the Rights of Persons with Disabilities (CRPD Committee) prepared a General Comment to clarify for treaty parties their obligation to ensure the realization of the right of persons with disabilities to work and employment. It emphasizes key principles such as equal opportunities, non-discrimination, reasonable accommodation, accessibility, and social protection measures. This guidance aims to promote inclusivity and empower persons with disabilities in the workforce.
The World Bank has been supporting countries like Bulgaria, Latvia, Lithuania, Romania, and Uzbekistan in analyzing their policies and conducting diagnoses of the situation of persons with disabilities as input into strategic plans for improving employment opportunities through evidence-based recommendations.
Breaking Barriers and Ensuring Equal Opportunities
Persons with disabilities oftentimes face significant challenges in accessing the open labor market, hindering their full inclusion and participation in society. Despite government efforts in many countries, barriers such as an outdated disability assessment system, stigma, discrimination, lack of legal protection, inaccessible workplaces, limited employer awareness of incentives, and demanding labor laws persist. To ensure equal access to the labor market, reforms are necessary in disability assessment, legal protection, employment quotas, and employer awareness. Accurate data collection on disability prevalence and employment is crucial for developing effective policies. Strengthening legal protection, promoting labor rights awareness, enforcing employment quotas, and fostering workplace accessibility and inclusion are essential steps towards overcoming these challenges.
Enhancing Vocational Training Opportunities
Persons with disabilities often have limited access to vocational training programs, hindering their employment prospects. Reforms are necessary to develop inclusive vocational training programs tailored to the needs of persons with disabilities and the labor market. Measures such as curriculum updates and offering support services can improve access to vocational training for persons with disabilities.
Addressing Social and Economic Insecurity at Work
Employed persons with disabilities often face social and economic insecurity, with a higher likelihood of holding insecure, part-time positions and informal sector employment. It is crucial to transition from the outdated system of sheltered workshops to inclusive workplaces and to promote formal employment for persons with disabilities. Providing incentives, raising awareness, simplifying registration processes of economic activities, and ensuring accessibility are recommended steps to foster disability-inclusive employment.
Creating an Inclusive Labor Market for All
Promoting the right to work and employment for persons with disabilities requires a comprehensive approach. By implementing the principles outlined in CRPD General Comment No. 8, addressing barriers, enhancing vocational training opportunities, and tackling social and economic insecurity, countries can create inclusive labor markets that enable persons with disabilities to fully participate in society and contribute to their communities’ development and prosperity.
World Bank Reports
Bulgaria Disability System and Policy: A Comprehensive Review
Disability Policy and Disability Assessment System in Latvia
Lithuania - Disability Policy and Disability Assessment System
Diagnosis of the Situation of Persons with Disabilities in Romania
Coordination and Monitoring: Ensuring the Rights of Persons with Disabilities
Implementing the United Nations Convention on the Rights of Persons with Disabilities (CRPD) requires the establishment of a comprehensive framework for coordination and monitoring.
Establishing the national implementation and monitoring framework
Designating the national focal point and coordination mechanism
To effectively implement the CRPD, states must designate a focal point within the government. This focal point collaborates with other institutions, collects monitoring data, and ensures the involvement of persons with disabilities in policy formulation. Additionally, the focal point submits country reports to the CRPD Committee. Establishing a coordination mechanism facilitates dialogue among various stakeholders involved in realizing the rights of persons with disabilities.
Enabling independent monitoring
Independent mechanisms, such as ombudsmen offices or human rights organizations, play a crucial role in promoting, protecting, and monitoring CRPD implementation. These mechanisms verify government measures, oversee service quality, and handle complaints related to violations against persons with disabilities.
Meaningful participation in monitoring
It is vital to include persons with disabilities and their representative organizations in decision-making processes that affect their lives. Governments should allocate resources to empower individuals with disabilities, enabling them to contribute informed opinions. Their active involvement ensures that measures taken by the government align with the CRPD. Moreover, persons with disabilities can prepare “alternative country reports” to present their perspectives on the observance of disability rights.
Developing a national roadmap for CRPD implementation
Aligning national policies
Aligning national policies with the CRPD necessitates the development of an implementation roadmap. This roadmap should outline specific measures, set timelines, and establish clear monitoring indicators to track progress. To ensure effectiveness, these measures should be based on an analysis of the challenges faced by persons with disabilities at the national level under different sectors (such as social protection, including disability assessment systems, independent living and community-based services, or employment) and should undergo extensive consultation with all relevant stakeholders.
Assistance from the World Bank
The World Bank has supported countries like Romania and Uzbekistan in defining their implementation roadmaps and monitoring plans. These efforts have resulted in a comprehensive toolkit that offers guidance and support to countries undertaking similar initiatives. This toolkit serves as a valuable resource for countries striving to align their policies with the CRPD and ensure the realization of disability rights.