Examining the health and wellbeing of persons with disabilities in Liberia

1. Examining the health and wellbeing of persons with disabilities in Liberia Dr Maria Kett, Ellie Cole, Mark Carew Leonard Cheshire Disability and Inclusive Development Centre UCL Dr Tim Colbourn Institute for Global Health, UCL

2. Presentation outline • Introduction and background • Subjective and objective wellbeing • Initial analysis • Health • Education • Empolyment and Income • Transport • Participation • Crime and Safety • Next steps

3. Background

4. The project • DFID/ESRC Poverty Alleviation funding • Persons with disabilities and their households • Objectives • Multidimensional poverty • Subjective and objective wellbeing • Effects of poverty reduction policies

5. Global disability • 15% of the world’s population live with a disability • Disproportionately represented in low- and middle-income countries • Disability and multidimensional poverty • Education • Un- and underemployment • Individual and household level

6. Wellbeing • Move away from solely economic indicators • Objective • ‘Material’ • Externally observable and measurable • Subjective • ‘Perceived’ • Values and standards of individuals

7. Liberia • Civil conflict ended in 2003 • Profound effect on population and country development • 63% are under 25 • 3.0 million (70%) in multi-dimensional poverty • HDI: 177/188 (2015) • Signed UNCRPD 2007; ratified 2012 • Disability data • 2008 Census • Core Welfare Indicators Survey 2010 • Ebola outbreak (2014/2015)

8. National Human Rights Action Plan, 2013-2018 • Persons with disabilities specifically highlighted as a target group • Not yet ratified or implemented – lack of budgetary allocation • Range of human rights domains, including • Civil and political rights • Right to participate • Right to education • Right to employment • Right to an adequate standard of living • Right to social security • Right to health • Women’s rights • Persons with disabilities’ rights

9. Survey domains • Household details and asset index • Health and health services • Ebola questions • Education and literacy/numeracy • Work and employment • Transport • Social and community interactions • Crime and safety • Political engagement

10. Research design • Quality of life ‘snapshot’ • Quantitative wellbeing survey • Cummins - Personal Well-being Index • Washington Group short set questions • Core set of questions with additional tailored items for disabled respondents and heads of household • Qualitative research • Focus group discussions • Policy maker key informant interviews

11. Qualitative research • Five Districts: • The total of thirty-four (34) Individual Interviews, including County Development Superintendents • Twenty two (22) focus group discussions (FGDs) – men and women with disabilities; EVD survivors

12. Sampling • Non-disabled household • Disabled household Head of household Head of household Match Person with disabilities Other

13. Research activities • Background activities – April 2014-December 2015 • Review of ‘quality of life’ indicators • Analysis of existing national data • Review of social policies • Ebola (2014/2015) • Data collector/supervisor training – January 2016 • Data collection/entry – February-July 2016 • Data analysis – August 2016-

14. Respondent Characterisics

15. Poverty

16. How would you compare your standard of living to other households in your community?

17. Education data

18. Impairments and assistive devices • 379 respondents (~70% of disabled) reported needing assistive devices – walking stick (24%); crutches (16%); glasses (15%) • 129 respondents reported needing support from others to move around • Half (49%) ‘only occasionally’ or never had access to the needed support • The main reason given was cost (70%)

19. Demographic information • Total sample = 2,020 (46.8% male; 53.2% female) total number of HH = 992 • Mean age 44.1 years (s.d 16.5; range 17-97) • Mean household size 5.2 people (s.d. 2.1; range 1-16)

20. Six respondent types

21. Respondents: Education

22. Respondents: Wealth quintile

23. Wellbeing

24. Wellbeing (overall life satisfaction)

25. Wellbeing (overall life satisfaction)

26. Wellbeing (overall life satisfaction)

28. Health

29. Health – overall satisfaction

31. Health – access to services

32. Health – satisfaction with health care received

33. Health – getting needed healthcare

34. Employment and Income

35. Work - satisfaction

36. Work - income

37. Transport

38. Transport - satisfaction

39. Transport – getting access when needed

40. Participation

41. Social relationships – Satisfaction with relationships with Friends, Household, Partner

42. Voting *1=Yes (sometimes or always); 0=No; the two respondents who refused the question were coded as missing

43. FGD Respondents • Contradictory evidence around responses, e.g. Participation/decision making processes: • “well, in my community, I am highly respected even in community meetings, they send my citation and I make some impact” (Male with disabilities, Mont. Bonardfarm) • “for me, the community I live in, disabled people are not respected by the community members...people with disability are not taken care of in this county and I say so, we are not respected in this county” (Male with disabilities, Grand Cape Mount) • Why do some people feel more empowered than others?

44. Crime and Safety

45. Crime – Satisfaction with Personal, Household and Community safety

46. Crime – personal experience or witnessing of crime *1=Yes (once, or more than once for personally experienced crime, or household member witnessed a crime); 0=No (not experienced crime in the past year); 'don't know' (88; 7%) and 'refused answer' (99; 3%) to question H1_3 recoded as missing

47. Next steps • Further data analysis • Washington group functional disability • Floor and ceiling of satisfaction questions • Clustering of disadvantages across sectors • Gender analysis • Qualitative research • More detail on interesting findings • Linking to political and institutional factors

48. Delete and add picture Thank you! • Questions? • m.kett@ucl.ac.uk • ellie.cole@ucl.ac.uk • t.colbourn@ucl.ac.uk