WATER GLOBAL PRACTICE Including Persons with Disabilities in Water Sector Operations A Guidance Note About the Water Global Practice Launched in 2014, the Word Bank Group's Water Global Practice brings together financing, knowledge, and implementation in one platform. By combining the Bank's global knowledge with country investments, this model generates more firepower for transformational solutions to help countries grow sustainably. Please visit us at www.worldbank.org/water or follow us on Twitter at https://twitter.com/search?q=%40WorldBankWater&src=tyah. Including Persons with Disabilities in Water Sector Operations A Guidance Note © 2017 International Bank for Reconstruction and Development / The World Bank 1818 H Street NW, Washington, DC 20433 Telephone: 202-473-1000; Internet: www.worldbank.org This work is a product of the staff of The World Bank with external contributions. 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Any queries on rights and licenses, including subsidiary rights, should be addressed to World Bank Publications, The World Bank Group, 1818 H Street NW, Washington, DC 20433, USA; fax: 202-522-2625; e-mail: pubrights​@­worldbank.org. Cover Photos: Hazel Jones/WEDC; WaterAid/James Kiyimba; WaterAid/GMB Akash/Panos. Cover design: Jean Franz, Franz & Company, Inc. Contents Acknowledgments vii Abbreviations ix Chapter 1  Introduction 1 1.1 Purpose 1 1.2 Need for Disability Inclusion in Water Sector Operations 1 1.3 Emerging Global Policy Framework for Disability Inclusion in Development 4 1.4 The World Bank’s Policy Framework for Disability Inclusion 5 Notes 5 Chapter 2  Key Issues in Water Access for Persons with Disabilities 7 2.1 Overview 7 2.2 Lack of Attention to Disability in Water Resources Management 7 2.3 Water, Sanitation, and Hygiene 10 2.4 Water in Agriculture 12 2.5 Water-Related Risks and Persons with Disabilities 14 2.6 Displacement and Resettlement 14 Notes 15 Chapter 3  Approaches to Disability-Inclusive Water Sector Operations 17 3.1 Twin-Track Approach to Disability Inclusion 17 3.2 Application of the Social Model of Disability and Inclusion to Operations 17 3.3 Policy Development and Implementation 17 3.4 Data Gathering and Statistical Analysis of Need and Impact 19 3.5 Building the Capacity of Decision Makers and Stakeholders 21 3.6 Designing Accessible Physical Infrastructure 23 3.7 Involving Persons with Disabilities across the Project Life Cycle 29 3.8 Ensuring Access to Information and Communications 31 3.9 Monitoring and Evaluation 33 Notes 33 Chapter 4  Entry Points in World Bank Processes 35 4.1 Country Strategy 35 4.2 Financing 35 4.3 Advisory Services and Analytics 40 Note 40 Including Persons with Disabilities in Water Sector Operations iii Appendix A  Resources 41 Design Guides and Manuals 41 Toolkits 41 Informational Videos 41 Boxes 2.1. Promoting Ownership of Water Sources: CBM 12 2.2. Supporting Agricultural Workers with Disabilities: The AgrAbility Projects by the U.S. Department of Agriculture 13 3.1. Disability Data Collection in Poverty Diagnostic of the Water Supply, Sanitation, and Hygiene Sector in Tajikistan 19 3.2. Obtaining Disability Disaggregated Data 20 3.3. Cost of Barrier-Free Design in Water, Sanitation, and Hygiene 26 3.4. Case Study: The Government of India’s Initiatives to Improve Accessible Water and Sanitation Resources 27 3.5. Role for Community-Based Rehabilitation in Accessible Water Operations 30 4.1. Mainstreaming Case Study: Disability-Inclusive Development in Indonesia 36 Figures 3.1. Structure of Capacity-Building Workshop on Accessible Water Services 22 B4.1.1. Example of Design Specifications for an Accessible School Toilet, Developed for the PAMSIMAS Project in Indonesia 38 Photos 1.1. Accessible Toilets in Paynesville, Liberia: A Woman, Who Is Blind, Works as the Caretaker 2 1.2. Young Boy Reaches for the Tap: Facilities Can Be Designed to Be More Accessible for Users with Diverse Needs 4 2.1. “Water for All” Community Water Tap, in Arua, Not Accessible to Persons Using Wheelchairs 8 2.2. Barriers to Water Access 11 2.3. Barriers to Sanitation 11 2.4. A Simple Adaptive Tool: Quick Bucket Opener by GEMPLER’S 13 2.5. An Adaptive Device: Outside Faucet Turners by Aids for Arthritis 13 3.1. Two Wooden Posts Are Landmarks Guiding a Woman Who Is Blind to the Toilet and Water Source 23 3.2. To Use Family Latrine, a Ugandan Carpenter, Olupot, Designed His Own Portable Toilet Seat and a Tippy Tap for Handwashing 24 3.3. Examples of Grip Bars for Support 26 3.4. An Accessible Toilet in Beltola Slum, Dhaka, Bangladesh 28 4.1. A Low-Cost Adapted Latrine in Bangladesh 36 iv Including Persons with Disabilities in Water Sector Operations Tables 2.1. Examples of Challenges, Based on Type of Disability 8 3.1. Examples of the Twin-Track Approach 18 3.2. Examples of Types of Access Barriers Using WaterAid Template 18 3.3. Examples of Policy Actions to Promote Access to Water, Sanitation, and Hygiene Resources 18 3.4. Solutions for Information and Communication Accessibility 31 3.5. Sample Indicators for Disability Inclusion in Water Operations 32 Including Persons with Disabilities in Water Sector Operations v Acknowledgments This Guidance Note is a result of collaboration between Campaign Manager, Bank Information Center), Claire the Social, Urban, Rural and Resilience Global Practice, Chase (Economist, World Bank), Louisa Gosling (Quality the Disability-Inclusive Development Knowledge Silo Programmes Manager, WaterAid), Dan Jones (Advocacy Breaker, Social Inclusion Global Solutions Group, and Coordinator, Healthy Start Campaigns, WaterAid), Priya Water Global Practice, prepared with financial support Nath (Equality, Inclusion and Rights Advisor, WaterAid), from the Water and Sanitation Program. Rosemary Rop (Water and Sanitation Specialist, World Bank), and Jane Wilbur (Equality, Inclusion and Rights The Guidance Note was prepared by a team led by Advisor, WaterAid, currently seconded to London Charlotte McClain-Nhlapo (Global Disability Advisor, School of Hygiene and Tropical Medicine). Helpful World Bank) with Deepti Samant Raja (Disability and advice and comments were received from Maitreyi Das Development Consultant, World Bank) as the principal (Lead Social Development Specialist, World Bank), author and key inputs provided by Lauri Sivonen Kamila Galeza (Consultant, World Bank), and Pilar (Senior Social Development Specialist, World Bank). Maisterra (Practice Manager, World Bank). Valuable contributions were received from Emcet Tas (Young Professional, World Bank) and Dea Widyastuty Thanks are due to Pascal Saura (Senior Knowledge and (Operations Analyst, World Bank). Learning Officer, World Bank) and Erin Barrett The team acknowledges and thanks peer reviewers (Consultant, World Bank), for their guidance and help Rachel Burton (Disability and World Bank Safeguards with the production of this note. Including Persons with Disabilities in Water Sector Operations vii Abbreviations AusAID Australian Agency for International Development CBR Community-Based Rehabilitation CDC Centers for Disease Control and Prevention CLTS Community-Led Total Sanitation CPFs Country Partnership Frameworks CRPD Convention on the Rights of Persons with Disabilities DPOs Disabled Persons’ Organizations ESF Environmental and Social Framework GPS Global Positioning System M&E Monitoring and Evaluation MDS Model Disability Survey MSJE Ministry of Social Justice and Empowerment PAMSIMAS Penyediaan Air Minum dan Sanitasi Berbasis Masyarakat or Community-Based Water Supply and Sanitation Project SCDs Systematic Country Diagnostics SDGs Sustainable Development Goals SMS Short Message Service TDD Telecommunications Device for the Deaf TTY Teletypewriter UN United Nations UNICEF United Nations Children’s Fund USB Universal Serial Bus WASH Water, Sanitation, and Hygiene WEDC Water, Engineering and Development Centre WHO World Health Organization WRM Water Resources Management Including Persons with Disabilities in Water Sector Operations ix Chapter 1 Introduction 1.1 Purpose and disaster resilience (photo 1.1). The note provides recommendations to support systematic and sustain- Globally, more than a billion people—approximately able interventions for disability-inclusive operations in 15 percent of the world’s population, or one in seven the World Bank’s water portfolio. The guidance note is persons—have disabilities. Of those, 80 percent live in primarily intended for staff and consultants in the developing countries.1 This number is expected to Water Global Practice, but will also benefit staff work- increase as the prevalence of disability is impacted by ing in related sectors. disease, war and conflict, natural disasters, and road traffic injuries, among other factors. In addition, per- The note collates recommended strategies and sons over the age of 60 comprise 12 percent of the ­practices in disability-inclusive development program- world’s population; that proportion is set to rise over ming. It identifies entry points for disability-inclusive 20 percent by 2050. There is a strong correlation 2 water operations in World Bank Group–supported between aging and the onset of disability. programs, projects and advisory services, and analyt- ­ ics. Case studies, including World Bank Group and Persons with disabilities make up a sizable portion of external examples, are provided to highlight the use of the 2.4 billion people who still lack access to sanita- recommended practices. In addition, the annexes list tion, and the 663 million who lack access to safe drink- several technical assistance resources to support task ing water.3 Although there are inadequate data to teams and clients in ensuring that infrastructure and assess the exact number of persons with disabilities services are inclusive of persons with disabilities. who face water scarcity and lack of access, there is evidence that points to the relative marginalization ­ 1.2 Need for Disability Inclusion in Water and invisibility of this population in water sector Sector Operations development programs. A 2011–12 survey of 16 Area Disability is a complex and multidimensional concept. Development Programs run by World Vision in Ethiopia The Convention on the Rights of Persons with showed that 96.6 percent of people with disabilities Disabilities5 identifies persons with disabilities as and the elderly faced difficulties in accessing basic those “who have long-term physical, mental, intellec- water facilities.4 tual or sensory impairments which in interaction with Disability-inclusive development programming is various barriers may hinder their full and effective par- directly responsive to the World Bank’s twin goals of ticipation in society on an equal basis with others.” ending extreme poverty and promoting shared pros- This conceptualization emphasizes the impediments perity. Ensuring that persons with disabilities are and disabling barriers that individuals experience in systematically and effectively included in World Bank ­ their physical and social environments. Persons with water sector operations is important for fully achieving disabilities face attitudinal, infrastructural, and envi- these goals. ronmental barriers in accessing water resources and sanitation facilities. These barriers further limit their This guidance note offers an overview of the key issues social, economic, and civic participation. Individuals and challenges that persons with disabilities face in also experience the onset of disabilities as they age. accessing water resources. These include activities such as water for drinking and household needs, sani- The 2011 World Report on Disability highlighted the tation and hygiene, water-dependent occupations, bidirectional link between poverty and disability.6 Including Persons with Disabilities in Water Sector Operations 1 PHOTO 1.1. Accessible Toilets in Paynesville, Liberia: A Woman, Who Is Blind, Works as the Caretaker Photo credit: WaterAid/Ahmed Jallanzo. Persons with disabilities face significant challenges in Its intersectionality with gender, race, ethnicity, indig- pathways to financial independence and economic enous group identity, migrant worker status, and other self-sufficiency, including accessing education, transi- characteristics can lead to unique and multiple forms tioning into the labor market, and accessing financial of exclusion and discrimination. The ripple effects of commodities. At the same time, their households face the lack of access to water resources can have serious greater out-of-pocket expenses, and often reduced socioeconomic consequences for persons with disabil- household income for other members due to caregiv- ities and their families, as described in the following. ing demands. Persons with disabilities also face higher 1.2.1 Social Impacts of Dependency for rates of multidimensional poverty compared with Water Access their peers without disabilities. In addition, poverty Dependency on others for accessing water resources— raises the level of health, occupational, disaster, and including drinking, sanitation, hygiene, and other risks that can result in long-term impairments. ­ irrigation—can result in adverse and unsafe personal Disability is a cross-cutting issue that can impact consequences for persons with disabilities. The big- person at any point across their lifespan. a  ­ gest concern is that dependency on others for basic 2 Including Persons with Disabilities in Water Sector Operations sanitation and water needs highly increases the risks adults with disabilities limit how much they eat or of sexual and financial exploitation, as well as deterio- drink during the day when they do not have access to rating health and hygiene. Women with disabilities, in sanitation facilities. This increases the risk of dropping general, face high risks of prolonged domestic and out of school or employment, and raises concerns of sexual violence. The uncertainty of being able to secondary medical conditions. Inaccessible WASH access water resources and facilities curtails the abil- facilities are a significant barrier to employment ity and willingness to venture to public spaces and and education. The exclusion of persons with disabil- engage in community activities or social interactions. ities from the labor market is estimated to cost middle-­ Limitations in contributing to household needs for income countries from US$338.55 billion up to water collection and storage, due to environmental US$480.21 billion, and low-income countries between barriers, tend to reflect on family and community per- US$135.36 billion and US$192.00 billion.7 ceptions of an individual’s worth, perpetuating nega- The ability to access and use water sources is essen- tive stereotypes of disability. tial to water-based and water-dependent occupa- Being able to control and manage one’s basic sanita- tions, agriculture being the most dominant. tion and water needs is also strongly linked to human Engagement in agricultural activities is crucial in dignity and self-esteem. These issues are compounded agrarian and rural communities where the primary for women with disabilities, as they face additional occupations are heavily dependent on water sources. ­ privacy and access challenges in dealing with men- Inaccessibility of irrigation resources and lack of strual hygiene, childbirth, and related side effects such accommodating aids and devices can completely as fistula and incontinence. exclude persons with disabilities from participating in agricultural and other water-dependent occupa- 1.2.2 Economic Impacts on Households tions. This situation can lead to significant household Households with members who have disabilities pay hardship, especially if the head of household is a for additional out-of-pocket expenses for structural person with a disability. modifications and adapted equipment to enhance access to water resources for all types of needs, such as The United Nations Children’s Fund (UNICEF) lists water, sanitation, and hygiene (WASH); irrigation; and inaccessible toilets and water facilities as a major fac- natural disaster management. Families who cannot tor for girls and boys with disabilities dropping out of afford to implement these modifications usually make school.8 Overall, children with disabilities attend and difficult choices between accessible water facilities complete primary and secondary education at lower and other basic needs. Many families depend on com- rates than children without disabilities. The gaps are as munal facilities and do not have the means to make high as 40–60 percent in low- and middle-income personal modifications. Households also face higher countries such as Cambodia, Bolivia, and Indonesia.9 expenses due to the direct and indirect costs of care Inclusive education efforts are further undercut when when the inaccessibility of water resources increases children prefer not to go to school due to inaccessible the dependency and lack of autonomy of persons with toilets. For example, a study showed that adolescent disabilities. girls with disabilities in Uganda were dropping out because the latrine design prevented them from enter- 1.2.3 Economic and Educational Participation ing and closing the door. In addition, caregivers—most Safe and reliable access to WASH facilities is a predom- often mothers and siblings—miss work and school to inant factor in educational, economic, and social par- assist children at schools with inaccessible WASH ticipation for persons with disabilities. Children and facilities. Including Persons with Disabilities in Water Sector Operations 3 1.2.4 Risk of Secondary Health Conditions and 1.3 Emerging Global Policy Framework for Disabilities Disability Inclusion in Development Early life exposure to poor WASH can increase the risk There is a strengthening global mandate for countries of developing a disability later in life, including mal- to ensure that persons with disabilities have equal nourishment-induced blindness and physical and cog- opportunity to participate fully in society and are part nitive impacts of stunting. Children with existing of economic development. disabilities are at increased risk for developing ­multiple disabilities because of the negative health implications The 2006 Convention on the Rights of Persons with of lack of WASH access (photo 1.2). In addition, poor Disabilities (CRPD),10 which came into force in 2007, WASH access can lead to serious, and at times fatal, has been ratified by 173 countries as of April 20, 2017.11 secondary health conditions for persons with disabili- CRPD enshrines the principles of respect for inherent ties, such as dehydration, pressure sores, urinary tract dignity and individual autonomy, nondiscrimination, infections, constipation, and other bowel and bladder full and effective participation, accessibility, and health problems. equality of opportunity, among others, for persons with disabilities. Article 28 (Adequate standard of living Finally, persons with disabilities are not the only and social protection) requires States Parties to ensure group that may experience functional difficulties that access to clean water services, as well as appropriate impede or restrict access to water resources across life and affordable services. Article 19 (Living independently domains. Community members at large can bene- and being included in the community) addresses equity fit  from barrier-free designed infrastructure and in needs-responsive community services and facili- services.  Accessible and universal design is good ties, and Article 9 (Accessibility) requires access to the design, especially for older persons, pregnant women, physical environment and public spaces and services children, women carrying children, and persons with in rural and urban areas. In addition to CRPD, United temporary injuries. Nations Member States have affirmed the right of every individual to water and sanitation through other trea- PHOTO 1.2.Young Boy Reaches for the Tap: Facilities ties, resolutions, and declarations.12 Can Be Designed to Be More Accessible for Users with Diverse Needs The 2030 Agenda for Sustainable Development clearly states that disability cannot be a reason or criteria for lack of access to development programming. The collection of disability-disaggregated data is necessary ­ for the implementation and monitoring of the Sustainable Development Goals (SDGs). SDG 6 (Ensure availability and sustainable management of water and sanitation for all) requires governments to pay special attention to the needs of people in vulnerable situa- tions, to achieve adequate and equitable sanitation and hygiene for all. SDG 6 underlines the need for com- munity participation in improving resources. In addi- tion, SDG 4 (Ensure inclusive and equitable quality Photo credit: A. Kwesell/World Bank. education and promote lifelong learning opportunities 4 Including Persons with Disabilities in Water Sector Operations for all) requires the design of education facilities to be of ending extreme poverty and promoting shared responsive to the needs of students with disabilities. prosperity raise the need to ensure that all persons SDG 10 (Reduce inequality within and among coun- can  benefit from development operations and tries) requires the social, economic, and political inclu- policy  reforms. The new Environmental and Social sion of all, including persons with disabilities. Framework (ESF), set to be operational in 2018, makes several direct references to safeguarding the interests The New Urban Agenda commits to equal access for of persons with disabilities (details in section 4.2.1.3). persons with disabilities to spaces, facilities, and ser- In conjunction with the Directive on Addressing vices open to the public in rural and urban areas. The Risks  and Impacts on Disadvantaged or Vulnerable Agenda encourages the “elimination of legal, institu- Individuals or Groups, ESF requires an assessment tional, socioeconomic and physical barriers,” to pro- of project risks and impacts, and identification of dif- mote equitable and affordable access to safe drinking ferentiated mitigation measures for disadvantaged water and sanitation for persons with disabilities. or  vulnerable individuals, including persons with The guiding principles of the Sendai Framework for disabilities. A specific good practice note on ESF and Disaster Risk Reduction 2015–2030 state that disability persons with disabilities will be available shortly. should be included in all disaster risk reduction poli- cies and practices. The Commitments to Action made Finally, task teams must mitigate the risks and causes at the World Humanitarian Summit held in Istanbul in for grievance actions due to adverse impacts of their 2016 include commitments to meet the needs of per- operations on persons with disabilities. Disabled sons with disabilities in crisis response operations and Persons’ Organizations (DPOs) are increasingly service delivery. More than 140 United Nations engaged and attentive to the design, delivery, and Member States and agencies, humanitarian organiza- inclusion of World Bank projects and programs. tions, and civil society organizations have endorsed Complaints about exclusion from major development the Charter on Inclusion of Persons with Disabilities in projects and services financed by the World Bank Humanitarian Action. Group can trigger significant revisions to implementa- tion plans midway, expensive corrective action and These international instruments provide the moral retrofitting, and complaints to the Inspection Panel. imperatives to break barriers to water access writ large, as well as a framework for implementation in develop- Notes ment programming. The World Bank can play an important role in supporting client governments as 1. World Health Organization and World Bank, 2011, World Report on Disability, accessed May 31, 2017, http://www.who.int/disabilities​ they work to fulfill their obligations toward CRPD and /­world_report/2011/report.pdf. the SDGs, through financing, policy development 2. United Nations Department of Social and Economic Affairs, 2013, assistance, and technical assistance. “World Population Ageing 2013,” accessed March 9, 2015, http:// www.un.org/en/development/desa/population/publications/pdf​ 1.4 The World Bank’s Policy Framework for /­ageing/WorldPopulationAgeing2013.pdf. Disability Inclusion 3. World Bank, 2017, “Water Overview,” accessed June 1, 2017, http:// www.worldbank.org/en/topic/water/overview. In addition to these international mandates, the World Bank’s policy framework makes a strong case for dis- 4. R. Singh, H. Honda, B. Frost, and K. Urich, 2014, “Casting the Net Further: Disability Inclusive WASH,” World Vision International, ability-inclusive development in its operations. As accessed June 1, 2017, http://www.wvi.org/clean-water-sanitation​ mentioned in section 1.1, the World Bank’s twin goals -and-hygiene-wash/publication/disability​-inclusive​-wash-report. Including Persons with Disabilities in Water Sector Operations 5 5. Convention on the Rights of Persons with Disabilities, G.A. Res 9. World Health Organization and World Bank, 2011, World Report on 61/106, UN Doc A/RES/61/106, 2006, New York: United Nations. Disability, accessed May 31, 2017, http://www.who.int/disabilities​ /­world_report/2011/report.pdf. 6. World Health Organization and World Bank, 2011, World Report on Disability, accessed May 31, 2017, http://www.who.int/disabilities​ 10. Convention on the Rights of Persons with Disabilities, G.A. Res /­world_report/2011/report.pdf. 61/106, UN Doc A/RES/61/106, 2006, New York: United Nations. 7. J. Noga and G. Wolbring, 2012, “The Economic and Social Benefits 11. The up-to-date list of countries that have signed and ratified and the Barriers of Providing People with Disabilities Accessible CRPD  and its Optional Protocol is available at http://www.un.org​ Clean Water and Sanitation,” Sustainability 4 (11): 3023–41. /­disabilities/countries.asp?navid=12&pid=166. 8. United Nations Children’s Fund, 2012, “Disabilities: Water, Sanitation, 12. See further: C. De Albuquerque, 2014, “Human Rights to Water and and Hygiene,” accessed May 31, 2017, https://www.unicef.org​ Sanitation,” United Nations Special Rapporteur, accessed June 1, /­disabilities​/index_65839.html. 2017, http://www.righttowater.info/handbook/. 6 Including Persons with Disabilities in Water Sector Operations Chapter 2 Key Issues in Water Access for Persons with Disabilities 2.1 Overview considered in water resources management. Persons with disabilities often face significant power differ- Disability inclusion in water sector operations includes entials in their communities, lack access to strong but goes beyond the last mile of access and service social networks, and may experience limited agency delivery (photo 2.1). It intersects with every aspect and and independence to influence WRM processes. In every phase of the broader approach to water resources many societies, disability is seen as a personal prob- management (WRM). Persons with disabilities face lem rather than through the lens of community physical, infrastructural, and cultural barriers to diversity. High dependency on others due to inacces- equity in water access (table 2.1). Some of these barri- sibility of water resources (as described in sections ers require local and situational modifications, while 1.2.1, 1.2.2, and 1.2.3) reinforces stereotypes about others need institutional changes, all of which should “being a burden to families and communities,” be premised on a paradigm shift in thinking about per- or  “lacking the capacity to participate.” Negative disabilities as direct beneficiaries of water sons with ­ perceptions about the lack of capacity and productiv- sector development projects. ity of persons with disabilities also lead to assump- Often, the gaps faced by persons with disabilities are tions that they will not go to school or hold a not identified or addressed in overarching plans and job, further amplifying the belief that disability is a ­ processes to manage water resources. This results in ­ problem for the household and not the community. disability needs being entirely overlooked in policy, Persons with disabilities may remain “invisible” in some infrastructure development, and service delivery. ­ communities, due to the lack of accessible public infra- Specific technical needs must be addressed, depending structure and communal spaces. Subsequently, their on the thematic nature of the operation, such as water needs and concerns remain invisible in stakeholder and sanitation resources, construction of dams, irriga- participation and consultations. Persons with disabili- ­ tion projects, or flood resilience and management. ties may not be invited to attend community consulta- This section lays out the barriers that result in ineq- tions on WRM or receive any information about  such uity in access to water resources arising from social processes (see sections 3.7 and 3.8 for recommendations and institutional barriers, and then focuses on specific to ensure inclusive outreach and consultations). Family issues that require attention in thematic subsectors. members are often considered de facto proxies or ­ representatives in public consultations; however, in 2.2 Lack of Attention to Disability in Water many cases, family members may hesitate to raise con- Resources Management cerns, due to societal stigma about disability. 2.2.1 Impact of Social Exclusion and Invisibility in 2.2.2 Institutional Challenges the Community Institutional processes and capacities impact the level Social attitudes about disability influence the extent and quality of access to water resources for persons with to which the needs of persons with disabilities are disabilities. Policies and regulatory frameworks Including Persons with Disabilities in Water Sector Operations 7 PHOTO 2.1. “Water for All” Community Water Tap, in Arua, Not Accessible to Persons Using Wheelchairs Photo credit: R. Burton/Bank Information Center. TABLE 2.1. Examples of Challenges, Based on Type of Disability Physical • Walking on uneven, unstable, narrow, or slippery surfaces (mobility, dexterity, and physical • Traveling long distances strength) • Reaching and operating controls; manipulating switches, parts, fasteners, and handles • Opening, closing, and latching doors • Having difficulty squatting over pit latrines, balancing, and needing to sit • Holding, lifting, and carrying containers, hoses, and other equipment • Carrying heavy weights • Assistive aids or devices, such as wheelchairs and crutches, do not fit in water and sanitation facilities or have to be supported against dirty surfaces table continues next page 8 Including Persons with Disabilities in Water Sector Operations TABLE 2.1. continued • Needing incontinence aids, such as bed pans • Being unable to afford the costs of using water resources, for example, fees to use facilities such as bore holes, public water taps, and community sanitation facilities; home modifications; and buying adaptive devices Visual • Having difficulty finding holes in pit latrines; danger of slipping with larger holes or damaged latrines • Assistive aids such as white canes do not fit in water and sanitation facilities or have to be sup- ported against dirty surfaces • Having difficulty in accessing information relayed through print media, text-only information on TV programs, or signing print-based documents and forms • Navigating new surroundings when all signage is in text • Entering, navigating, and using new physical spaces • Being unable to distinguish between colors (for example, to differentiate between the wall and door of a latrine cubicle) due to low vision Hearing • Having difficulty in accessing information relayed through vocal media, such as radio programs, TV programs without captions, and community loudspeakers • Hearing sirens and other sounds (for example, in a flooding situation) • Facing barriers in communicating and interacting with relevant stakeholders, including in com- munity meetings and consultations • Relying on others to express their views and needs in community planning meetings and consul- tations Speech • Facing barriers in communicating and interacting with relevant stakeholders, including in com- munity meetings and consultations • Relying on others to express their views and needs in community planning meetings and consul- tations • Expressing personal needs, such as menstrual pain Cognitive • Assistive aids or devices such as wheelchairs and crutches do not fit in water and sanitation facili- (includes a range of conditions that ties or have to be supported against dirty surfaces may impact a person’s memory, • Having difficulty in communicating needs for water resources as well as personal hygiene needs thinking and problem-solving, read- • Needing information in visual formats ing and language comprehension, • Needing incontinence aids, such as bed pans and ability to pay attention or follow instructions) • Needing navigation and memory aids in finding, accessing, and using water resources • Relying on others to express their views and needs in community planning meetings and consul- tations Psychosocial • Experiencing social isolation and exclusion, which impedes receiving information on water resource management and participation in planning meetings and consultations • Having difficulty in communicating needs for water resources as well as personal hygiene needs • Needing navigation and memory aids in finding, accessing, and using water resources • Relying on others to express their views and needs in community planning meetings and consul- tations Including Persons with Disabilities in Water Sector Operations 9 overseeing the allocation, development, and mainte- is designed without consideration of the access needs nance of water resources may not consider or include of persons with different types of functional limita- accessibility and access for persons with disabilities. This tions. These barriers differ based on the type of disabil- leads to low to no allocation of financial and physical ity, use of in-house versus communal WASH facilities, resources to ensuring that persons with disabilities are household economic capacity, and urban versus rural equal beneficiaries of water sector services and programs. environments. In some cases, persons with disabilities are unable to Common barriers include the following: afford fees for using communal facilities such as irrigation facilities, boreholes, public water taps, and public latrines. 1. Distance to water points. Long distances to water It is hence important to identify financial barriers to the points are a challenge for persons with mobility access and use of water resources for persons with dis- limitations in rural and urban areas. These barriers abilities. Financial assistance or relief can be provided are  amplified by difficult terrain and poor road through innovative fee structures, such as sliding-scale conditions that impede mobility for persons using ­ fees and loans or grants to individuals or communities to assistive devices such as wheelchairs or prosthetic ­ make accessibility modifications for the use of water limbs, limited accessible transport options, and resources. navigation barriers for persons with visual disabilities. A frequently cited barrier is the lack of practitioner 2. Design of water points and sanitation facilities. The knowledge and capacity on understanding and address- most common design barriers include lack of ramp ing barriers for persons with disabilities. This is reflected access, uneven and high steps, small entryways, in the lack of policies and action plans mainstreaming lack of handrails or supports, and difficult pump disability; lack of accessibility standards, guidelines, handles. Latrine spaces can be difficult to maneuver and specifications; and limited awareness of existing while using a wheelchair or other mobility aids, and guidance documents and manuals. There are gaps in individuals may be unable to use the latrine itself. coordination and partnership between government bodies that oversee water resources and delivery, and 3. Design of handwashing facilities. In addition to these those that focus on the implementation of laws, poli- physical barriers, persons with disabilities may face cies, and regulations related to disability inclusion. difficulties in manipulating and turning different types of taps (for example, taps with rings); the hand wash- Institutional barriers are also evident when persons ing basin might be too high; or the tap might be too far with disabilities cannot engage in water resources limited upper from the front of the basin. Persons with ­ management themselves. This includes lack of partici- limb mobility or strength may find it difficult to draw pation in stakeholder consultations and outreach water from a container for handwashing. activities, but more importantly the lack of persons 4. Carrying and transporting water. Many persons with with disabilities in leadership and management roles disabilities may have trouble carrying water with at the community, local, and national levels. traditional buckets and containers. Difficulties in ­ holding, carrying, and balancing water containers are 2.3 Water, Sanitation, and Hygiene serious impediments to water access and use. In Persons with disabilities can face several barriers to some  resource-limited environments, people may physically using WASH facilities in their households, have to carry their own water into public spaces schools, work sites, health facilities, markets, and such  as health facilities. Difficulty in carrying and other public spaces. Most public WASH infrastructure transporting water can be a serious impediment to 10 Including Persons with Disabilities in Water Sector Operations accessing other necessary ser- PHOTO 2.2. Barriers to Water Access vices in such situations. 5. Accessing water for household Sleep Contaminated needs. Even when stored or muddy unprotected slopes piped water is available, per- sources sons with disabilities may face Broken challenges in using it for their uneven steps own hygiene needs, such as High platform No platform bathing and handwashing, or for household purposes, such Danger of as cooking. Simple issues can Path falling leads into well become major barriers, such as through No lifting inability to use water in a seated trees and mechanism position, or needing help with bushes filling and tilting containers. Long Handpumps Muddy distance ground exhausting Uneven slippery to water 6. Safety concerns. Lack of to operate High well paths sources well attention to the physical con- struction and location of Photo credit: WaterAid.1 WASH facilities and poor maintenance also give rise to PHOTO 2.3. Barriers to Sanitation safety risks for persons with disabilities. Examples include broken steps, slippery floor Girls’ and Boys’ School toilets surfaces, steep surfaces, and No door- close together - impossible No door lack of lack of privacy to keep lack of navigation aids or privacy clean fencing around deep bore- holes and wells. It is also Unstable Very wide No menstrual hole liable essential to address safety drop hole hygiene to collapse ­ precautions during the con- management (MHM) High platform facilities struction of any water infra- with no step Dark structure. For example, roads inside that are dug up to lay water Nothing Narrow Nothing to Door hard pipes should have physical door to hold hold onto to close barriers that would alert a onto Lack of when from space stepping inside person who is blind from Steps inside walking into the pit. High steps Slippery Photo: Handicap Photos 2.2 and 2.3 offer a glimpse tiles International Sri Lanka oor of common WASH access barri- ers for persons with disabilities. Photo credit: WaterAid.2 Including Persons with Disabilities in Water Sector Operations 11 A recent study by WaterAid, WEDC, Leonard crossing irrigation canals can impede mobility for Cheshire Disability, and Share showed that although persons with disabilities. ­ disability-​inclusive WASH projects have increased in Persons with disabilities must be mainstreamed in volume and impact over the years, they remain a ­ conomic rural development projects that focus on e very small proportion of WASH development activi- growth through productive agriculture and related ties and financing.3 Most of the projects reviewed operations such as livestock rearing. Mainstreaming by the study were in the early stages, that is, situa- includes supporting measures to increase land tional analyses and pilot studies and activities. ­ ownership and access to water resources (for exam- Most of the projects only address the access needs ple, wells) (box 2.1). In many instances, persons with of persons with physical disabilities. A limited num- disabilities may be barred from owning such resources ber of projects were at later stages of the realization or denied loans to start their own businesses. This continuum, such as inclusion in organizational prac- can result from societal perceptions and stigma as tices at large. well as policy and business norms that de facto exclude persons with disabilities. Persons with dis- 2.4 Water in Agriculture abilities should be able to join and benefit from local farmer and water associations, as well as self-help Disability-inclusive water management is widely groups. beneficial to other members in the community, ­ including the elderly and pregnant women. The Simple accommodations and adaptations, at the user design and ­ construction of irrigation systems and or resource level, can make rainfed and irrigation-based other water ­ management resources can impose agriculture accessible to persons with disabilities ­ barriers to the participation of persons with disabili- (box  2.2; photos 2.4 and 2.5). Assistive devices and ties. For ­ example, ill-designed bridges or steps for adapted tools and services increase, maintain, or BOX 2.1. Promoting Ownership of Water Sources: CBM CBM, a civil society organization working toward the empowerment of persons with disabilities, has worked with counterparts in Niger to develop “survival yards” for persons with disabilities. The organizations worked with persons with disabilities and their families to develop gardens of 25 square meters along with digging wells and water canals for irrigation. These sources supplied water to gardens, boosting food production and livestock rearing. In addition, the wells and water canals became a source of water for neighbors and others in the village, showcasing the economic contribution and productivity of individuals with disabilities. CBM and its local partners further supported the design and provision of simple adaptations to ensure that persons with disabilities could use the water supply and work in their gardens. For example, for persons who are blind, the project team developed a bucket that, when filled with water, would automatically tip over into a basin, which would further pour into a canal for irrigation. Source: Inclusion and Survival in the Backyards of Niger, 2013, New Agriculturist, accessed April 11, 2017, http://www.new-ag.info/en​ /­focus/focusItem.php?a=3095. 12 Including Persons with Disabilities in Water Sector Operations BOX 2.2. Supporting Agricultural Workers with Disabilities: The AgrAbility Projects by the U.S. Department of Agriculture Since 1990, the U.S. Department of Agriculture has initiated and funded AgrAbility, a program to support the gainful employment and occupational participation of agricultural workers with disabilities, through the AgrAbility project. The U.S. Department of Agriculture funds a national Agrability project as well as state- and regional-level AgrAbility projects. AgrAbility projects provide information, direct support, and technical assistance to agricultural workers with disabilities and their families. Examples of activities funded by AgrAbility projects include the following: • Assessing an individual’s needs and carrying out accessibility audits at agricultural worksites and for s ­ pecific work tasks • Recommending assistive devices, adaptive equipment, and farm and home modifications • provision of assistive technology, making customized devices and modifications • Referring persons with disabilities to local service providers • Offering financial advice, loans, and grants to farmers and ranchers with disabilities, to support agricultural activity (for example, building a drip irrigation system) • Sharing information and best practices for agricultural workers with disabilities, and developing and disseminating knowledge materials, including fact sheets, handbooks, and webinars ­ • Sharing knowledge and building capacity for relevant stakeholders. Read further at http://www.agrability.org/. PHOTO 2.4. A Simple Adaptive Tool: Quick Bucket PHOTO 2.5. An Adaptive Device: Outside Faucet Opener by GEMPLER’S Turners by Aids for Arthritis Photo Credit: GEMPLER’S. Photo Credit: Aids for Arthritis. Including Persons with Disabilities in Water Sector Operations 13 improve the functional capabilities of persons with community resilience-building activities, or capacity-​ disabilities. These accommodations and adaptations building interventions. Disability-inclusive resilience can include the following: planning and interventions, including financial assis- tance and social protection systems, can limit the nega- • Less labor-intensive sprinklers or drip-irrigation tive effects of social, physical, housing, health, economic systems to reduce physical labor network, and resource disruptions. Including disability • Adaptations to water pumps, gears, and water-­ in disaster risk mitigation can address needs for accessi- lifting devices bility at each stage of disaster recovery and rebuilding. • Locally made and sourced customized contraptions, 2.6 Displacement and Resettlement such as prosthetic hooks and handles to improve clutching, holding, and lifting functions Infrastructure-heavy projects such as hydropower and  dam construction have significant effects on • Modified tools local  communities. Displacement and resettlement • Basic mechanization of occupational tasks. ­ activities may increase the risks of exclusion and mar- ginalization for persons with disabilities. Forced dis- Organizations working with persons with disabilities placement and resettlement leads to inevitable, and have also encouraged the use of horticulture and often long-term, disruptions in services. Households home-based gardens and cultivation for economic with members with disabilities may have a harder time activity. finding appropriate replacements for the resources, net- works, and services they lose due to forced displacement 2.5 Water-Related Risks and Persons and resettlement. First and foremost, they may face with Disabilities physical accessibility barriers in the temporary housing Persons with disabilities and their households are provided, including in WASH facilities. As discussed in particularly vulnerable in water-related disasters such ­ section 1.2.1, persons with disabilities are at risk of phys- as flooding. Existing inequities, as described in the sec- ical, sexual, and economic abuse in instances of reduced tions above, are amplified during hazard events, lead- privacy and increased dependency for basic needs. ing to disproportionately negative impacts for persons Disruption in access to education is one of the issues with disabilities. Vulnerabilities can include lack of commonly highlighted as a negative impact for persons preparation at the household level in terms of flood with disabilities. Families of children and youth with proofing, inaccessible warning systems, inability to disabilities may have invested substantial resources for evacuate, having to reside in shelters and temporary services, such as access to schools and related support ­ housing without accessible WASH facilities, and assistive devices or therapists. Resettlement to other increased out-of-pocket and household expenditure areas can have a significant effect on school participa- for reconstruction. The resulting impacts of a natural tion if there are limited options for accessible schooling disaster on financial self-sufficiency, workforce reinte- in resettled areas.4 Inclusive and accessible schooling gration, and socioeconomic participation can trigger a options may be too far away or not accessible through vicious cycle of continuing marginalization. available transportation options. Similarly, disruptions At the same time, disability may not be a targeted to employment and economic activity create even consideration in disaster risk reduction activities. ­ more hurdles for persons with disabilities than persons The  needs of persons with disabilities may not be without disabilities, due to social hurdles and discrimi- included  in community vulnerability assessments, nation in employment. 14 Including Persons with Disabilities in Water Sector Operations By rooting equity for persons with disabilities in Cash benefits and compensation given to overarching water resources management, disability ­ persons with disabilities may not be inclusion can become a part of policy making, regulatory sufficient to cover the expenses they incur, frameworks, governance, infrastructure development, especially if no additional support is given and community mobilization to support water security. to meet accessibility needs. Families would be required to make out-of-pocket Notes expenditures to fund any needed housing 1. H. Jones, L. Gosling, S. Jansz, and E. Flynn, Equity and Inclusion in modifications, buy new adaptive WASH Provision: Using the Social Model of Exclusion, Water, equipment, or secure alternative means of Engineering and Development Centre and WaterAid. transport. 2. H. Jones, L. Gosling, S. Jansz, and E. Flynn, Equity and Inclusion in WASH Provision: Using the Social Model of Exclusion, Water, Engineering and Development Centre and WaterAid. 3. WaterAid; Water, Engineering and Development Centre; Leonard It is also important to ensure that persons with disabil- Cheshire Disability; and Share, 2012, “Mainstreaming Disability and ities who have given up land for construction of new Ageing in Water, Sanitation and Hygiene Programmes,” accessed WASH infrastructure, or have construction on their June 1, 2017, http://www.wateraid.org/news/news/mainstreaming​ -disability-and-ageing-in-water-and-sanitation-programmes. property, also have access to the new water access facilities. This access should take into consideration 4. Bank Information Center, 2013, December 3, BIC Disability Campaign takes trip to Uganda, accessed June 14, 2017, http://www​ the distance and terrain to be traveled by persons with .bankin ​­ f ormationcenter.org / bic-disability-c ampaign-takes​ disabilities to access these facilities. -trip-to-uganda/. Including Persons with Disabilities in Water Sector Operations 15 Chapter 3 Approaches to Disability-Inclusive Water Sector Operations 3.1 Twin-Track Approach to 3.3 Policy Development and Disability Inclusion Implementation The twin-track approach involves (i) mainstreaming Policies are critical for guiding and enforcing the devel- disability across water sector operations by breaking opment, implementation, and monitoring of disability-­ barriers to access in consultations, needs assessments, inclusive development efforts (table 3.3). Policies can infrastructure development, and service delivery, and draw from legislation and offer concrete steps and (ii) undertaking targeted projects to respond to gaps in guidance to government officials, WASH practitioners, programming and specific areas of need for persons and vendors on accessibility in water sector operations. with disabilities. Using the twin-track approach to dis- Explicit mention of disability in policy and regulatory ability inclusion in water sector operations will expand frameworks guiding the water sector can cultivate the benefits of all projects to persons with disabilities, institutional inclusion of disability and mainstreaming while also targeting the main barriers to inclusion. of accessible design. Inclusion of disability in water operations requires Disability inclusion in water sector policies and changes in the “hardware” and “software” aspects of national action plans leads to the development of water operations. Table 3.1 provides some examples of budget allocation; accessibility guidelines, standards, activities under the two tracks. Activities should be and codes; capacity-building programs; and technical based on situational analyses. resources. Policies can mandate accessibility require- 3.2 Application of the Social Model of ments in public procurement processes and decision Disability and Inclusion to Operations making. Importantly, policies can promote the inclu- sion of disability in reporting requirements, longitudi- The social model of disability presents a paradigm shift nal assessments, and impact evaluations. from thinking of disability only through the medical lens of health conditions and functioning. The social Many countries have passed or are developing legisla- model asserts that lack of opportunities, indepen- tion that promotes the rights of persons with disabili- dence, and participation arises from social, commu- ties, especially upon ratification of CRPD. Disability nity, and environmental obstacles rather than the rights and anti-discrimination legislation is usually underlying health condition itself. This is an empower- characterized by the following:1 ing lens to apply to any project and identify the barri- • Seeks to uphold and reinforce the basic and funda- ers that impede the full participation of persons with mental rights—political, civil, economic, social, and disabilities in society. cultural—of persons with disabilities as citizens WaterAid has developed a simple template that can be used to identify barriers for persons with disabilities • Lays out mandates to eliminate discrimination against persons with disabilities across life domains across different types of water operations (table 3.2). (such as water and sanitation, public access, hous- Barriers can be caused by naturally occurring chal- ing, education, and health care) and promote equal- lenges, infrastructure design, policy and institutional ity of opportunity systems, and the prevailing social stereotypes and atti- tudes about disability. Table 3.2 shows how the tem- • Creates measures and systems to support the reali- plate can be applied. zation of rights and nondiscrimination. Including Persons with Disabilities in Water Sector Operations 17 TABLE 3.1. Examples of the Twin-Track Approach Twin-track approach to disability inclusion in water sector operations Mainstreaming Disability-specific • Incorporating accessibility into design standards and guidelines • Carrying out audits and assessments of barriers for persons • Holding disability-inclusive consultations with disabilities • Modifying, constructing, and adapting services and facilities for • Teaching accessibility in regular design curricula persons with disabilities • Including disability indicators in monitoring and evaluations • Building the capacity of water sector practitioners on disability needs TABLE 3.2. Examples of Types of Access Barriers Using WaterAid Template Category Barrier Physical, natural • Slippery paths, natural obstructions, steep river banks, muddy springs, and rugged terrain • Long distances to water resources Physical, infrastructural (See table 2.1 for examples of disability-specific access barriers.) • Raised steps, narrow entrances, no handrails, and raised height of aprons or pumps • Heavy water pump handles, and difficulty in carrying and transporting water • Lack of signage and information in alternative formats Policy, institutional • Lack of explicit policy mandates on accessible water services • Lack of practitioner knowledge and capacity • Budget and resource allocation does not account for accessibility • Poor implementation of disability laws and policies • Lack of or low implementation of accessibility standards for designs and building codes Social, cultural, and attitudinal • Reinforced stereotypes of being a burden • Persons with disabilities not expected to go to school or hold a job • Girls and women with disabilities deal with general taboos on menstruation as well as misconcep- tions about their reproductive health and hygiene needs because of their disability • Assumptions that family members can take care of all needs • Sexual and financial exploitation in exchange for helping with water and sanitation needs • Not invited to consultations, lack of agency, and few social networks TABLE 3.3. Examples of Policy Actions to Promote Access to Water, Sanitation, and Hygiene Resources Water sector policy actions Disability policy actions • Promote equity and inclusion of persons with disabilities • Focus on nondiscrimination and full participation • Allocate resources with accessibility requirements in • Include requirements for barrier-free environments, public procurement accommodations, and access to assistive technology • Develop processes for universal access • Mandate minimum standards • Mandate minimum standards • Create legal channels for recourse and grievance mechanisms for • Develop timelines and milestones for universal water coverage persons with disabilities 18 Including Persons with Disabilities in Water Sector Operations Policies on inclusive water services can also clarify the 3.4 Data Gathering and Statistical Analysis roles and responsibilities of various ministries and of Need and Impact departments, and create pathways for successful col- The lack of data on persons with disabilities is a signif- laboration and coordination between the relevant gov- icant challenge for policy makers, development practi- ernment authorities. Otherwise, the policies would tioners, and inclusion advocates. When groups are tend to be a cause for confusion, as disability affairs invisible in the data, their needs are often invisible in tend to come under the ministries of social welfare or the policies and programs. Similarly, there is a lack of health at the national and state levels. There needs to disability aggregators in monitoring and evaluation be strong collaboration and coordination between the plans and processes. disability focal departments and the ministry and departments responsible for water and sanitation, Disability-inclusive data gathering is essential to agricultural resources, and disaster management. develop evidence-based action plans and schemes Many countries have progressive policies on disabil- and plan resource allocation appropriately. One of the ity inclusion, but there is a gap between what is on most cost-effective ways to document the needs of paper and what occurs in practice. Hence, imple- persons with disabilities, and the impact of water mentation plans must translate inclusion goals into operations, is to include disability aggregators in ongo- concrete targets that are monitored and assessed in ing household surveys and data-gathering processes evaluations. (box 3.1, box 3.2). BOX 3.1. Disability Data Collection in Poverty Diagnostic of the Water Supply, Sanitation, and Hygiene Sector in Tajikistan The Household WASH Survey, conducted as part of the Poverty Diagnostic of the Water Supply, Sanitation, and Hygiene Sector in Tajikistan, used the short set of questions from the Washington Group on Disability Statistics to identify households with members with disabilities, and included questions to assess their access to water, sanitation, and hygiene (WASH) resources. The resulting data point to the prevalence of functional difficulties in the population. Of the 3,019 households interviewed for the WASH survey, about 55 percent, or 1,673 households, reported having at least one household member with one or more functional disability, at various severity levels. This includes persons with mild levels of disability, but reflects how common functional difficulties (including walking, climbing, and self-care) are in the population, and bolsters the argument about the numbers of persons who benefit when WASH resources are designed to be easier to use. Of the sampled households, 9 percent indicated that they have at least one household member who has one or more of the six functional disabilities at the highest severity level. The most common type of disability is being unable to perform self-care (6.6 percent), followed by being unable to walk or climb (4.5 percent). box continues next page Including Persons with Disabilities in Water Sector Operations 19 BOX 3.1. continued The survey results offer further insights into the challenges or constraints for household members with disabilities in accessing water resources: • About 24 percent of the households reported that persons with disabilities in their household can- not access the main water source without assistance from others; a higher number of rural households (29 percent) reported this issue as compared with urban households (12 percent). • Fourteen percent reported that persons with disabilities in their household have some or a lot of difficulty in accessing the main water source. • The most commonly cited barriers were distance to the water source (17 percent), carrying or transport- ing water (11 percent), lack of accessibility features such as ramps (12 percent), and difficulty of terrain (9 percent). This analysis is a step toward filling the data gap on WASH access for persons with disabilities. The findings can inform future water investments in Tajikistan. Source: World Bank team, Poverty Diagnostic of the Water Supply, Sanitation and Hygiene Sector, Tajikistan. BOX 3.2. Obtaining Disability Disaggregated Data • Ensure that household surveys can be disability disaggregated • Include disability disaggregation in baseline and evaluation surveys • Use indicators on persons with disabilities • Include questions on physical and environmental barriers in WASH or other relevant surveys • Conduct detailed, disability-specific population surveys • Include qualitative data collection for in-depth understanding of needs and experiences There are several issues to consider when developing accessing water resources for agriculture and other census-type surveys to assess disability prevalence: water-dependent occupations. i. Disability should not be conceptualized only on the ii. A single categorical question on disability, which basis of the underlying medical condition. Rather, asks, “Do you have a disability?” with a yes/no the focus needs to be on the limitations and barriers answer choice or multiple options, such as blind- a person encounters in accessing water and sanita- ness, deafness, and so forth, offers limited evidence tion resources, managing personal hygiene activi- and information. It is difficult to capture every cate- ties, undertaking the activities of daily life, and gory of disability in such a list. In addition, a person 20 Including Persons with Disabilities in Water Sector Operations with one category of disability can face multiple 4. Do you have difficulty remembering or concentrating? functional limitations. For example, a person with 5. Do you have difficulty (with self-care such as) washing cerebral palsy may have difficulty with mobility, all over or dressing? communication, and cognitive processing. 6. Using your usual (customary) language, do you have iii. Disability can vary greatly in severity from person difficulty communicating, for example understanding to person. For example, a question that asks, or being understood? “Are  you blind?” may leave out persons with low vision. It captures only people with the highest One of the advantages of using these six questions is severity of disability, leaving out others who also that they tap into adults who may have some level experience functional limitations and difficulties in of functional difficulties but do not self-identify as conducting the activities of daily living, skewing being disabled. This is particularly relevant for the the results. elderly and persons with mild levels of disability, especially in cultures that stigmatize disability. The Data should be collected in a manner that is most iv. findings thus provide a clearer understanding of helpful to government programming, budget allo- the  range of individuals who will benefit from cation, and policy. It is most helpful to assess the inclusive design and adaptations in access to water number of individuals who are at “greater risk than resources. the general population of experiencing restrictions in performing tasks (such as the activities of daily UNICEF and the Washington Group on Disability living) or participating in roles (such as education).” 2 Statistics developed a module on child functioning By focusing on how many persons experience diffi- and disability for use in censuses, sample-based culties in conducting the activities of daily life, gov- national surveys, or other statistical formats.5 The ernments can assess the need for supporting module is designed for children ages 2 to 17 years. programs that promote accessibility for the wider The Model Disability Survey (MDS), developed by the benefit of the community. World Health Organization and the World Bank, is The Washington Group on Disability Statistics has another questionnaire aimed at developing a stan- developed a short set of six questions and an extended dardized instrument for disability measurement.6 set to assess functioning in adults.3 The short set is MDS is a general population survey to assess the well-suited for census-type population and household functioning and barriers faced by persons, and a surveys, and widely used for disability disaggregation. detailed assessment of environmental factors, func- The Washington Group’s short set focuses on levels of tioning, capacity and health conditions, and assis- difficulty due to health problems across six domains, tance aids and devices. MDS is based on the and assesses the level of difficulty in each domain. For 4 International Classification of Functioning, Disability, each question, the answer choices are the following: and Health. no, no difficulty; yes, some difficulty; yes, a lot of diffi- culty; and cannot do at all. The short set is as follows: 3.5 Building the Capacity of Decision Makers and Stakeholders 1. Do you have difficulty seeing, even if wearing glasses? Capacity-building activities for government officials 2. Do you have difficulty hearing, even if using a (across all relevant ministries), community leaders hearing aid? including faith leaders, development practitioners, 3. Do you have difficulty walking or climbing steps? engineers, and architects should combine awareness Including Persons with Disabilities in Water Sector Operations 21 raising with the development of technical skills to • Future trainings and workshops on accessibility and respond to the needs of persons with disabilities. inclusion for WASH practitioners, architects, and All  relevant stakeholders should be identified and engineers involved in capacity-building activities. For example, it is important to raise the knowledge and capacity of • Disability-disaggregated data collection, and inclu- sion in monitoring and reporting. educators to ensure that school WASH facilities are accessible, and involve health practitioners in ensur- Figure 3.1 shows the general structure of most ing access to water resources within health care inclusive capacity-building workshops. disability-­ facilities. Similarly, capacity building should engage The twin-track approach is valuable in conducting government officials across all relevant ministries, capacity building. Sessions or modules on equity and such as those responsible for water and sanitation inclusion should be incorporated into the mainstream resources, agriculture, health, education, social pro- capacity building of stakeholders and communities. tection, and labor. The desired outcomes of capacity-­ Disability-focused capacity-building activities can building activities are the following: facilitate a deep-dive exploration of barriers and solu- • Changes in policy (including procurement policies) tions based on the disability type, geographic and and action plans to ensure accessibility in water demographic nature of the location, community operations, including the development of disability-­ resources, and level of existing knowledge and skills. inclusive national sanitation policies Engaging persons with disabilities as facilitators is an essential part of good practice. • Development and/or adoption of accessibility standards Disability community leaders, DPOs, and disability service • Resource allocation for disability-inclusive water providers can be trained in working with development operations practitioners, engaging in water projects, and understand- • Mainstreamed disability inclusion in active or pipe- ing the technical details of water operations. line water development programs at the national, Capacity building should become an iterative process state, or local level that is integrated into the larger learning ecosystem. • Inclusion of disability in pilot and demonstration One-point-in-time trainings may lead to awareness projects raising and sensitization, but may not be sufficient to FIGURE 3.1. Structure of Capacity-Building Workshop on Accessible Water Services Raise awareness Problem Skills and Continue Equity and solving solutions to engage inclusion Discuss needs Effective M&E, follow-up Social model and barriers in practices, case workshops, Water studies, share continuing Policy/legal operations resouces education imperatives Note: M&E = monitoring and evaluation. 22 Including Persons with Disabilities in Water Sector Operations translate into long-term action. Complementary and sanitation resources. It is important that accessibility ­ supplementary workshops and on-site trainings and safety audits identify and address the needs of should be provided, with technical resources and guid- girls and women with disabilities, such as facilities ance in the form of handbooks, manuals, and toolkits. for  menstrual hygiene management (privacy, dis- Universal  and accessible design principles and case posal bins with lids, accessible spaces to wash and dry studies can be integrated into architecture and engi- sanitary products, and incinerators). ­ neering curriculums. Access audits are an excellent tool to identify chal- lenges at a specific site or facility, for example, water 3.6 Designing Accessible Physical and sanitation facilities in a school, public water kiosks Infrastructure and hand pumps, and community irrigation facilities. 3.6.1 Overview The results of an audit are very helpful in guiding Water resource infrastructure and facilities should be reconstruction or retrofitting, and can help to break designed for barrier-free use by all individuals. Barrier- down barriers into high-priority accessibility issues free design aims to support independent use of water that need rebuilding, issues that can be addressed resources to the maximum extent possible. Physical through the procurement of assistive aids and technol- spaces and construction, such as WASH facilities, ogies, and those that require behavioral modifications should meet accessible design specifications and (photo 3.1). guidelines. PHOTO 3.1. Two Wooden Posts Are Landmarks 3.6.2 Conducting Infrastructure Accessibility and Guiding a Woman Who Is Blind to the Toilet and Safety Audits Water Source An audit of the accessibility and safety of any physical environment (including WASH, farming and irrigation, resources for flood management, and other physical facilities relevant to water use) for persons with dis- abilities helps to identify obstacles and barriers to independent access. The audit also flags safety con- cerns. Access audits are conducted by a team com- prised of end users, including testers with disabilities and experts on accessible design standards and specifi- cations. It is essential to include local experts and end users in access audits to ensure that the audits are grounded in user needs and cultural sensitivity. In addition, the audit should not focus only on specific types of disabilities but use a cross-disability approach. Audits can help identify access barriers for all mem- bers in a community, such as older persons, and not only persons with disabilities. Access audits help to identify safety concerns that are especially relevant for  women.  Women with disabilities may face heightened safety  risks in accessing water and ­ Photo credit: Hazel Jones/WEDC. Including Persons with Disabilities in Water Sector Operations 23 Examples: • Behavioral modifications. This example guides peo- ple to stop piling trash or parking vehicles blocking • Modification of construction. This example addresses public latrine entrances. the need to construct a ramp or gradient entryway, widen entrances, lower door handles, and change An audit should be followed up by developing solu- the type of water tap knobs. tions to address the identified barriers in consulta- • Adding aids or assistive devices. This example tion with users. Accessibility assessments should includes installing bright lights in dimly lit corri- include qualitative data collection with target users. dors, installing braille signage plates, providing Access barriers may arise due to community behav- modified toilet seats, designing customized low- iors or community attitudes toward disability. Open- cost contraptions to carry or pour water, and using ended questions can be used to assess whether there mechanized irrigation equipment such as drip are individuals who would like to use the facilities ­irrigation (photo 3.2). but are unable to do so, and explore the reasons why PHOTO 3.2. To Use Family Latrine, a Ugandan Carpenter, Olupot, Designed His Own Portable Toilet Seat and a Tippy Tap for Handwashing Photo credit: WaterAid/James Kiyimba. 24 Including Persons with Disabilities in Water Sector Operations • How easy is it to unlock and open the door or gate? Accessibility audits and assessments are (for example, by someone with a weak grip) known to have a strong and positive impact on stakeholder awareness and capacity • If there is an entrance, is it wide enough for a wheel- building. In many instances, an accessibility chair user to enter? (recommended minimum width assessment may be the first direct exposure 80 centimeters) a government official, school administrator, • Is there something for the user to lean on while or development practitioner may have to the drawing water? barriers and obstacles built into the everyday environment. Observing users’ • Is there a place to stand the water container? Can the difficulties in accessing basic services is a user easily lift the filled water container and carry it? trigger to understanding the issue and • Does the layout of [audited space such as a toilet] finding solutions. allow space for a wheelchair or crutch user or a user and helper? they are unable to do so. Such assessments should • What is the floor made of? Is it even or uneven, firm include questions on safety, especially instances or or unstable, slippery or nonslip? fear of harassment, violence, and sexual abuse. In • If squatting: is there something to hold onto when countries that have accessibility specifications within squatting? Rails, rope, or so forth; materials, finish, building codes or accessibility mandated by law, position, height, and so forth. these audits help in developing compliance plans. The annex provides a list of WaterAid toolkits to con- Audits during or after new construction help to ensure duct accessibility and safety audits for latrines and that the design and layout of the constructed facility is water points. indeed accessible by persons with disabilities (box 3.3, photo 3.3). Disability practitioners often cite examples 3.6.3 Applying the Principles of Universal Design of how modifications are poorly planned and executed. The Principles of Universal Design offer a good frame- For example, installed ramps may be too steep, or hand- work for developing inclusive structures in water rails around the toilet may inadvertently block the entry operations. Universal design means designing products to or use of other facilities, such as hand wash basins. and environments to be usable by all people, to the  greatest extent possible, without the need for Sample questions on an audit checklist include the adaptation or specialized design.8 The principles are as following:7 follows: • Is the path to [facility] well lit? • Equitable use. The design is useful and marketable to • Is the surface of the path slippery when dry or wet? people with diverse abilities. • Are there obstacles that make it difficult to get past • Flexibility in use. The design accommodates a wide or easy to trip up, especially for visually impaired range of individual preferences and abilities. people? (natural or material) • Simple and intuitive use. Use of the design is easy • If there is a slope or ramp, how steep is it? (compare to understand, regardless of the user’s experience, with recommended gradients) knowledge, language skills, or current concentra- • Is there a handrail for support? tion level. Including Persons with Disabilities in Water Sector Operations 25 BOX 3.3. Cost of Barrier-Free Design in Water, Sanitation, and Hygiene Accessible and barrier-free construction is always most cost-effective when accessibility requirements are built into the initial design. Retrofitting is costlier. Studies show that the additional cost of access features, when considered right from the start, is within 1 to 3 percent of the total cost of construction. The Water, Engineering, and Development Centre’s (WEDC’s) costing data from the construction of accessible school latrines in Ethiopia in 2009–10 showed that costs for access features were between 2 and 3 percent of the total construction cost. A single block ventilated improved pit latrine of eight cubicles in an urban school cost US$7,242.92, which included US$216.15 for access features (ramps, widened doors, support rails, and raised toilet seats). A single block dry pit latrine of eight cubicles in a rural school cost US$9,108.97, which included US$228.94 for access features (ramps, widened doors and cubicles, and support rails). The costs of making individual household latrines accessible through SBM India range from US$132.38 to US$173.05 (including features such as handrails, grab bars, ramps, painting, and advance road). When access features are included from the start, the entire design could be developed to minimize additional costs of material or labor. Many adaptations and assistive aids to facilitate access are low cost and include do-it-yourself solutions. The Compendium of Accessible WASH Technologies, by WEDC, WaterAid, and Share, offers a cost range for each recommended design feature. (The annex in this Guidance Note provides a list of toolkits.) Source: H. Jones, 2011, “Inclusive Design of School Latrines: How Much Does It Cost and Who Benefits?” Briefing Note 1. Water, Engineering and Development Centre, Leicestershire, United Kingdom. PHOTO 3.3. Examples of Grip Bars for Support Photo credit: WaterAid. 26 Including Persons with Disabilities in Water Sector Operations • Perceptible information. The design communicates functional limitations due to injuries and accidents, the necessary information effectively to the user, and needs due to aging. regardless of ambient conditions or the user’s sen- sory abilities. 3.6.4 Developing Manuals, Guidelines, and Toolkits on Accessible Design • Tolerance for error. The design minimizes hazards Comprehensive manuals and handbooks that include and the adverse consequences of accidental or unin- detailed technical specifications and measurements tended actions. on designing accessible water points, sanitation facili- • Low physical effort. The design can be used effi- ties, and community facilities are very useful in pro- ciently and comfortably with minimum fatigue. moting implementation (box 3.4). These resources can be customized to local contexts and produced in local • Size and space for approach and use. Appropriate size languages. Some manuals also provide details on esti- and space is provided for approach, reach, manipu- mating the costs for materials and design. Technical lation, and use, regardless of the user’s body size, specifications can ensure that the placement, design, posture, or mobility. space, and operation of water points and sanitation Universal design aims to be responsive to diverse facilities allow for access and use by persons with dif- needs in communities and human experiences, includ- ferent disabilities (photo 3.4). Accessibility specifica- ing pregnancy, carrying small children, temporary tions generally cover the minimum requirements for BOX 3.4. Case Study: The Government of India’s Initiatives to Improve Accessible Water and Sanitation Resources In October 2014, the Prime Minister of India launched the Swacch Bharat Mission to accelerate efforts for universal sanitation. With 8.3 percent of the households in India having members with disabilities, accessibility is one of the focus areas under the Swacch Bharat Mission. The rural sub-mission Swacch Bharat (Gramin) commissioned WaterAid India to develop the Handbook on Accessible Household Sanitation Facilities for Persons with Disabilities (PwD).a The handbook is a practical guide for a range of water, sanitation, and hygiene (WASH) stakeholders—government officials, engineers, representatives of Panchayati Raj institutions, WASH sector professionals, disabled persons’ organizations, and other civil society members—in designing and implementing needs-responsive solutions at the household level. The handbook offers guidance for actions at the state, district, village, and panchayat levels, along with technical specifications for sanitation facilities. It includes model and replicable solutions implemented in Jharkhand. In parallel, the Accessible India Campaign (Sugamya Bharat Abhiyan), launched by the Department of Empowerment of Persons with Disabilities, Ministry of Social Justice and Empowerment (MSJE), is promoting universal accessibility for persons with disabilities. As part of the campaign, MSJE has released Practitioners Manual: Making Water, Sanitation and Hygiene Accessible and Safe through improved Planning and Design.b The manual, developed by the Samarthyam National Centre for Accessible Environments, is a comprehensive document that covers the social and legislative context for accessible WASH. box continues next page Including Persons with Disabilities in Water Sector Operations 27 BOX 3.4. continued The manual provides detailed technical specifications on WASH planning, design, and implementation. The manual covers design standards, including appropriate materials, signage, and low-cost assistive aids. It further includes a section on child-friendly facilities in schools and community sanitation. The manual provides a checklist that can be used in WASH access audits. a. Source: Swachh Bharat Mission (Gramin), Ministry of Drinking Water and Sanitation, 2015, Handbook on Accessible Household Sanitation Facilities for Persons with Disabilities, Government of India, accessed April 14, 2017, http://www.mdws.gov.in/sites/default/files/Water%20Aid%20Handbook%20final.pdf. b. Department of Empowerment of Persons with Disabilities, Ministry of Social Justice and Empowerment, Practitioners Manual: Making Water, Sanitation and Hygiene Accessible and Safe through improved Planning and Design, Government of India, accessed June 14, 2017, http://disabilityaffairs.gov.in/upload/uploadfiles​ /­files/WASH%20Practitioners%20Manual-Samarthy.pdf. PHOTO 3.4. An Accessible Toilet in Beltola Slum, Dhaka, Bangladesh Photo Credit: WaterAid/Guilhem Alandry. 28 Including Persons with Disabilities in Water Sector Operations entryway dimensions, physical space in stalls, ramp members will assist them in addressing their water gradients, surface materials, tactile requirements, access needs.10 height of different access points, handrails and sup- DPOs and other disability organizations are natural ports, and signage. partners to ensure the inclusion of disability issues from the start. Local DPOs can help project teams in 3.7 Involving Persons with Disabilities identification and outreach to persons with disabilities across the Project Life Cycle in the targeted communities. 3.7.1 Disability-Inclusive Public Consultations When persons with disabilities are invited to consulta- One of the main reasons why disability issues are tions, the following accessibility guidelines should be rarely considered in the project planning and design kept in mind: phases is that persons with disabilities remain invisi- • The physical sites for consultations and meetings ble and excluded from public consultations. Deliberate should be accessible to persons with disabilities and concerted efforts are required to ensure that per- (for example, there should be alternatives to stairs, sons with disabilities and their families, DPOs, and accessible sanitation facilities, sufficient space to other organizations providing disability services are maneuver in wheelchairs, and no obstructions in invited to and included in all phases of water opera- areas reserved for meal breaks). tions. A  recent UNICEF report on accessible WASH projects highlights insights from WASH practitioners • Some individuals may need informational materials on how families may not allow persons with disabili- in alternative formats, such as Braille or large print, ties to attend consultations, and may be hesitant to or sign language interpreters at the consultations. raise the issues in community discussions without (DPOs can assist in identifying vendors and provid- prompts. Similarly, a rural WASH sustainability study 9 ers for these services.) in Papua New Guinea, commissioned by the World • Compensation provided for transport to the con- Bank’s Water and Sanitation Program, observed that sultations should reflect any additional expenses of although communities acknowledge the presence of accessible transport options that may occur. persons with disabilities, they assume that family • Some persons with disabilities may attend with personal caregivers. Engaging persons with disabilities can be a challenge for several reasons: Family members and caregivers should also be • Persons with disabilities may remain hidden included in these consultations. Project teams should take special care to ensure that women with disabili- or be invisible in their communities, due to ties are well represented. Often, the specific needs of stigma, community perceptions, and lack of accessibility. women with disabilities tend to be marginalized in dis- ability and women’s advocacy. If separate focus groups • In many communities, persons with disabili- are held to obtain insights from women on sensitive ties are deprived of agency, and family mem- issues such as privacy, violence, and abuse, women bers may be used to representing them. with disabilities should also be invited. • Community workers may feel that asking The increasingly used Community-Led Total Sanitation about disability is taboo or inappropriate. (CLTS) approach is a good mechanism to include per- sons with disabilities and their representatives, from Including Persons with Disabilities in Water Sector Operations 29 project initiation. Community triggering processes This includes the type of construction, period, and lead to a collective action plan and community mobili- expected interruptions to daily life activities, so that zation to build safe and enclosed sanitation facilities they can make contingency plans for travel and access and change community WASH behaviors. When per- to public spaces. sons with disabilities are not represented in triggering 3.7.2 Collaborative Partnerships with the processes, their needs tend to go unmet in CLTS Disability Community programs.11 This is detrimental to the CLTS goal of An important recommendation for disability-inclusive ending open defecation. development is to include persons with disabilities and Consultations should not be limited to identifying bar- their representatives as integral members of the project riers to water access; they should also focus on finding implementation teams (box 3.5). They should be solutions. Persons and with disabilities and their fami- included at all phases of the processes, from planning lies are often accustomed to figuring out adaptations to implementation to evaluation. Recommendations and may have rich insights into individual, household, for developing trusting and collaborative partnerships and communitywide solutions for accessible water with the disability community include the following: services. Community and citizen engagement advi- sory boards are another good entry point to include • Meaningfully involve persons with disabilities and disability organizations in all community partici- persons with disabilities and their representatives. patory processes, so that they can be a part of the Persons with disabilities should also be able to learn decision-making process on design, installation, about and access information on construction plans. and use. BOX 3.5. Role for Community-Based Rehabilitation in Accessible Water Operations Community-Based Rehabilitation (CBR) organizations can play a key role in promoting access to water resources. The World Health Organization initiated CBR in the 1970s as a strategy to address rehabilitation needs in developing countries, particularly in remote and rural areas that lacked human and material resources in medical rehabilitation. The fundamental principle in CBR is building the capacity of local communities and families to address the needs of persons with disabilities. CBR has now transformed from a medical model approach to a rights-based process for empowerment, social inclusion, and service delivery. CBR practitioners can conduct needs assessments at the household and community levels, developing customized solutions, using and making low-cost adaptations, and coordinating ongoing assessments and maintenance. For example, Mobility India, a nonprofit organization in Bengaluru, India, partnered successfully with government officials to use CBR approaches for inclusive water, sanitation, and hygiene (WASH). Mobility India leveraged existing community networks and self-help groups to reach out to persons with disabilities. Mobility India used street plays and wall paintings to share awareness about good WASH practices. Mobility India was also able to raise external funding that supplemented government grants secured by families to build accessible WASH facilities. Source: World Health Organization, 2010, “Community-Based Rehabilitation: CBR Guidelines,” accessed June 2, 2017, https://www.ncbi​ .nlm.nih.gov/books/NBK310943/. 30 Including Persons with Disabilities in Water Sector Operations • Engage DPOs and disability service providers as part- important to ensure that persons with disabilities can ners and consultants, especially during community access information and communications to facilitate assessments, design audits, decision-making meet- their engagement and participation in operations, ings, and monitoring and evaluation (M&E) activities. while also promoting their use of services and facilities. • Support and promote the hiring of persons with disabilities in water management and leadership Common forms of information dissemination roles. include printed material such as flyers, banners, • Implement inclusive employment and leadership to and billboards.  These will be inaccessible to help break stereotypes about persons with disabili- p ersons with print disabilities,13 unless alternative ­ ties within their communities. means of communication are also provided. Similarly, audio-based communications can be Water practitioners and disability experts can comple- inaccessible to persons with hearing impairments. ment each other’s strength and fill the other’s gaps in To include persons with disabilities in program knowledge.12 Working with disability experts also activities, consultations, and community partici- helps to build trust within the disability community in pation, and raise their awareness  and capacity to the target area. use water resources, it is essential that they can access the information and communication result- 3.8 Ensuring Access to Information and ing from the programs. Table  3.4 provides exam- Communications ples of alternative and accessible means of Access barriers are not exclusively limited to information and communication with persons with the  physical infrastructure domain. It is equally disabilities. TABLE 3.4. Solutions for Information and Communication Accessibility Disability category Examples of accessible solutions Visual disability • Information (including alerts) in audio format (including sirens, recorded messages, beeps on phones, and so forth) • Materials in Braille and large font • Documents in accessible electronic formats on USB drives, websites, and through e-mail • Screen readers, braille displays, magnification software and devices, voice recognition software, and audio descriptions Hearing disability • Sign language interpreters • SMS text messaging • Captions on videos and other multimedia • Voice and video relay services, teletypewriters (TTY) or telecommunication devices for the Deaf (TDD), closed captioning, subtitles, voice amplifiers • Use of vibrations/text alerts instead of audio alerts Speech impairments • SMS text messaging • Synthesized voice output and text-to-speech functionality • Use of virtual picture boards and communication solutions table continues next page Including Persons with Disabilities in Water Sector Operations 31 TABLE 3.4. continued Disability category Examples of accessible solutions Physical disability • Voice recognition systems • Adapted and virtual keyboards • Joysticks and adapted mouse Cognitive disability • Text-to-speech rendition and speech/voice output • Physical and electronic picture boards for communication • Multimedia to aid comprehension, for example, videos, graphics, and touchscreen devices • Mobile apps and online resources that mimic augmentative and alternative communication devices • Organization and memory aid tools, such as online calendars, note taking, and alerts • GPS-facilitated navigation Note: GPS = Global Positioning System; SMS = Short Message Service; TDD = telecommunications device for the deaf; TTY = teletypewriter; USB = Universal Serial Bus. TABLE 3.5. Sample Indicators for Disability Inclusion in Water Operations Sample indicators for evaluating outcomes for persons with disabilities General indicators • Number and frequency of women and men with disabilities consulted during project design and implementation • Access of women and men with disabilities to support services (such as home modifications, adaptive devices, credit, and mechanized equipment) to access water (for domestic, agricultural, or other uses) • Number of stakeholders trained in implementing disability-inclusive water resource management practices (specify as per project) • Percentage of trained stakeholders self-reporting increased knowledge of making water resources accessible for persons with disabilities • Number of legal/policy instruments proposed, drafted, or adopted to promote disability-inclusive water resource management at the national or subnational level as a result of project or program activities WASH indicators • Percentage of population using safely managed drinking water services, disaggregated for persons with and without disabilities • Percentage of population using safely managed sanitation services, disaggregated for persons with and without disabilities • Percentage of schools (primary and lower and upper secondary) with adapted infrastructure and materials for students with disabilities • Percentage of schools (primary and lower and upper secondary) with adapted WASH facilities for students with disabilities • Percentage of public buildings meeting relevant (for example, ISO 21542:2011)/ standards on accessibility and usability of the built environment • Percentage of population using an adequate sanitation facility, disaggregated for persons with and without disabilities • Percentage of population with disabilities using an adequate sanitation facility • Percentage of households in which the sanitation facility is used by all members of the household (including men and women, boys and girls, elderly, and people with disabilities) whenever needed • Percentage of drinking water points that are accessible to all users, including those with disabilities, throughout the school day • Percentage of direct beneficiaries that rate their access to water for domestic use as having improved during the period covered by the program or project • Percentage of health facilities with accessible WASH facilities table continues next page 32 Including Persons with Disabilities in Water Sector Operations TABLE 3.5. continued Sample indicators for evaluating outcomes for persons with disabilities Agricultural water management indicators • Access of women and men with disabilities to support services (such as adaptive devices, credit, and mechanized equipment) for agricultural purposes • Percentage of direct beneficiaries with disabilities that rate their access to water for agricultural use as having improved during the period covered by the program or project • Number of women and men with disabilities actively participating in water user groups • Number of women and men with disabilities in positions of management or leadership in water user groups • Number of landless women and men with disabilities with increased access to water from irrigation schemes during the period covered by the program or project Note: The list of sample indicators was borrowed or adapted from proposed indicators for the Sustainable Development Goals and indicators for gender inclusion in water management.14,15,16 WASH = water, sanitation, and hygiene. 3.9 Monitoring and Evaluation needed (see section 3.8 for information and communi- cation accessibility solutions). Project outcomes for and impact on persons with dis- abilities, their families, and communities should be assessed during standard M&E processes. Often, even Notes when project concept design and action plans mention 1. United Nations, 2007, “From Exclusion to Equality. Realizing the rights of persons with disabilities. Handbook for Parliamentarians on disability, it is completely missing in the targets and the Convention on the Rights of Persons with Disabilities and its indicators used to measure success and completion. Optional Protocol,” accessed June 14, 2017, from http://www.un.org​ Disability-inclusive M&E can strengthen the knowl- /­disabilities/documents/toolaction/ipuhb.pdf. edge base, build evidence for the use of different 2. Centers for Disease Control and Prevention, 2010, Washington Group approaches, and support the incremental realization on Disability Statistics – Rationale for the Short Set, accessed June 14, 2017, https://www.cdc.gov/nchs/washington_group/wg_rationale.htm. of full access and participation. 3. Washington Group on Disability Statistics, 2017, accessed Effective practices for disability-inclusive M&E are June 14, 2017, https://www.cdc.gov/nchs/washington_group/wg​ _­rationale.htm. as follows: 4. Washington Group on Disability Statistics, 2016, Short Set of • Develop disability-specific indicators (see table 3.5). Disability Questions, accessed June 14, 2017, http://www.washing​ tongroup-disability.com/washington-group-question-sets/short​ • Use mixed-method approaches for M&E. Qualitative -set-of-disability-questions/. data collection is valuable for understanding the 5. Washington Group on Disability Statistics, 2016, Child Functioning, direct and indirect impacts of interventions, allow- accessed June 14, 2017, http://www.washingtongroup-disability.com​ ing evaluators to explore the reasons why program /washington-group-question-sets/child-disability/ components worked or did not work, and gauging 6. World Health Organization and World Bank, 2017, Model Disability Survey, accessed June 14, 2017, http://www.who.int/disabilities/data​ continuing access gaps. /­mds/en/. • Collect data that can be disaggregated by disability. 7. S. House, S. Ferron, M.Sommer, and S. Cavill, 2014, Violence, Gender and WASH: A Practitioner’s Toolkit - Making water, sanitation and • Include partners from the disability community in hygiene safer through improved programming and services, the team of evaluators. WaterAid and SHARE. 8. Center for Universal Design, 1997, Universal Design Principles, Satisfaction and participant feedback surveys should accessed June 14, 2017, from https://www.ncsu.edu/ncsu/design​ be provided in accessible and alternative formats, if /­cud/about_ud/udprinciples.htm. Including Persons with Disabilities in Water Sector Operations 33 9. UNICEF (United Nations Children’s Fund), 2015, “Good Practices in the hold and manipulate printed materials. This category of disability Provision of Accessible and Inclusive Wash Services,” UNICEF country can include persons with visual, physical, cognitive, and learning offices, accessed June 2, 2017, https://www.unicef.org/disabilities​ disabilities. /­files/UNICEF_Accessible_Inclusive_WASH_Mapping_2_1.pdf. 14. Joint Monitoring Programme, World Health Organization, and United 10. Water and Sanitation Program, Papua New Guinea Rural WaSH Nations Children’s Fund, “Post-2015 WASH Targets and Indicators.” Sustainability Study, World Bank Group, accessed June 2, 2017, http:// https://www.unicef.org/wash/files/4_WSSCC_JMP_Fact_Sheets_4_UK​ pubdocs.worldbank.org /en/371311479450088833/PNG-WaSH​ _­LoRes.pdf. -Sustainability.pdf. “Module 15. 6. Gender Mainstreaming in Agricultural Water 11. J. Wilbur and H. Jones, 2014, “Disability: Making CLTS Fully Inclusive,” Management,” 2008, In Gender in Agriculture Sourcebook, Frontiers of CLTS: Innovations and Insights Issue 3, Brighton: IDS. Washington, DC: World Bank. 12. R. Singh, H. Honda, B. Frost, and K. Urich, 2014, “Casting the Net United 16. Nations, International Disability and Development Further: Disability Inclusive WASH,” World Vision International. Consortium, and International Disability Alliance, “SDG Indicators: Disability Advocacy Toolkit.” Accessed April 18, 2017, 13. Print disabilities include a range of disabilities that impact the effec- https://www​. add.org.uk/sites/default/files/UN_SDG_Disability​ tive reading of printed material. These can also include the ability to _­Indicators.PDF. 34 Including Persons with Disabilities in Water Sector Operations Chapter 4 Entry Points in World Bank Processes 4.1 Country Strategy 4.1.2 Country Partnership Frameworks SCDs inform the development of Country Partnership 4.1.1 Systematic Country Diagnostics Frameworks (CPFs). The findings from the SCD help to A recent review of the first 17 Systematic Country articulate the main country development goals in the Diagnostics (SCDs) showed that only three SCDs CPF. Hence, it is critical to ensure that disability is (Albania, Mali, and Serbia) mentioned persons with included in the SCD. Findings on the constraints and disabilities.1 SCDs are an important entry point to con- opportunities for inclusion of persons with disabilities textualize the exclusion of persons with disabilities in in the country’s broader water operations can help to a country, especially in access to water operations. justify and propose indicative disability-inclusion Although disability is a stigmatized issue in most water sector interventions in the CPF. countries, it is not usually a politically controversial issue. Persons with disabilities should be explicitly 4.2 Financing identified as a target group for analysis on key con- 4.2.1 Investment Project Financing straints to the inclusiveness of growth (photo 4.1). The 4.2.1.1 Twin-Track Approach to Project Design and SCD can lay out the domains in which persons with Implementation disabilities face barriers to participation (which will include the water sector), the nature of the barriers, The twin-track approach described in section 3.1 will and most importantly the reasons for their exclusion expand the benefits of all projects to persons with and marginalization from markets, services, and disabilities while also targeting the main barriers to ­ spaces. The following activities can help in developing inclusion. a disability-inclusive SCD: Examples of projects that can be good mechanisms for • Invite and ensure the participation of persons with disability inclusion in water operations include the disabilities and DPOs in public consultations (online following: consultations should follow accessibility guidelines) • Financing new construction and rehabilitation of water (see sections 3.7 and 3.8). management infrastructure, sanitation, and hygiene • SCD teams can partner with relevant government facilities. Water supply and sanitation in schools is a partners, DPOs, academics, and broader civil good example of an area for disability mainstreaming. society to develop joint analytical work to feed into ­ Children with disabilities should be identified as proj- the SCD. ect beneficiaries in the Project Appraisal Document, and the results framework should have disabili- • Include staff with disability and social inclusion ty-disaggregated indicators. In addition to physical expertise in review processes. construction of accessible school latrines and water • Where data gaps on persons with disabilities limit access points, the financing should support the the analyses, SCD teams should attempt to use tri- software aspects of inclusion as well. This includes angulation methods and flag the lack of disability-­ building the capacity of government officials, school disaggregated data for future analytics. administrators, communities, and families (box 4.1). Including Persons with Disabilities in Water Sector Operations 35 PHOTO 4.1. A Low-Cost Adapted Latrine in Bangladesh Photo Credit: WaterAid/GMB Akash/Panos. BOX 4.1. Mainstreaming Case Study: Disability-Inclusive Development in Indonesia The Penyediaan Air Minum dan Sanitasi Berbasis Masyarakat or Community-Based Water Supply and Sanitation Project (PAMSIMAS AF) in Indonesia is working to increase access to improved water and sanitation facilities and improved hygiene behaviors among low-income rural and peri-urban populations. The project is co-financed by the Government of Indonesia, World Bank, and Australian Agency for International Development (AusAID). Triggered by AusAID’s requirement to ensure inclusion of persons with disabilities as beneficiaries of development financing, the World Bank task team is supporting the Government of Indonesia in exploring mechanisms to mainstream disability across project activities. PAMSIMAS has introduced a disability- inclusive approach into its operations since November 2016, and is focused on mainstreaming disability across project activities. Disability is specifically included as part of vulnerable groups as defined in the project environmental and social safeguard technical guidelines. box continues next page 36 Including Persons with Disabilities in Water Sector Operations BOX 4.1. continued Implementing the twin-track approach to disability inclusion. Disability-inclusive programming is now part of PAMSIMAS strategy and implementation. The main elements include the following: • Institutionalizing disability inclusion in the project cycle and mainstreaming disability in project policies • Addressing disability inclusion starting from the community planning process • Including persons with disabilities in decision making and local institutions • Encouraging disabled persons’ organizations (DPOs) to facilitate the process when specific attention is needed • Developing disability-inclusive development training material for communities, and improving technical specification standards for accessibility, especially for school sanitation, hand-washing facilities, and public facilities • Updating community awareness and socialization materials • Implementing a community action plan review checklist at the district level that includes disability inclu- sion requirements • Encouraging local financing to support disability-inclusive development in community action plans. Disability-inclusive development trainings. The project hired CBM Australia to conduct a training on disability inclusion in development activities broadly and water, sanitation, and hygiene (WASH), for government officials, World Bank staff, and WASH facilitators. Fifty-five participants across different stakeholder groups attended the training. CBM Australia compiled the complementary Handbook on Inclusive WASH in Indonesia, which provides guidance based on the WASH program approaches used by PAMSIMAS, such as Community- Led Total Sanitation, Participatory Hygiene and Sanitation Transformation, and Sanitation Marketing. In addition, the project is socializing and training project stakeholders at the national and provincial levels, a district consultant team, and community facilitators in the planning process. Community implementation training. After the national training, PAMSIMAS included the topic of disability inclusion in community implementation training for facilitators, reaching about 4,200 individuals. Pilot projects in 200 villages. PAMSIMAS has initiated pilot projects on disability-inclusive WASH. Following the disability-inclusive community implementation training, facilitators identified 200 villages where pilots will be conducted. As part of the process, the project team is conducting reviews of the proposed technical design for villages in the pilot program (figure B4.1.1) reviews of 35 villages have been completed so far. The results of the reviews will be shared with local DPOs in a workshop, to obtain their feedback, which will be provided to the community facilitators team. Monitoring. Disability will be added as part of the process and outputs monitoring, including by uploading the information onto the web-based management information system (baseline population, existing access, participation in the community meetings, and beneficiaries). box continues next page Including Persons with Disabilities in Water Sector Operations 37 BOX 4.1. continued FIGURE B4.1.1. Example of Design Specifications for an Accessible School Toilet, Developed for the PAMSIMAS Project in Indonesia Water closet Septicktank Ø0.80 Kolom, 15/15 A B Hand rail Resapan 0.60 Improvement in technical 2.00 C C speci ications: Minimum requirement for room size, door width, A B height of water closet 1.00 Accessories: handrail, Sliding door lighting and paints, non- 1.00 slippery floor, signs 3.00 Access: ramp, tactile paving Denah Toilet for disabled Standard toilet Source: PAMSIMAS. Source: World Bank Project Team, Second Additional Financing to the Third Water Supply and Sanitation for Low Income Communities, Indonesia. • Projects (especially community-driven development) Disability-specific activities include stand-alone supporting community empowerment and institutional disability projects and subproject-level interventions ­ development at the national, local, and village levels. to address specific development gaps and barriers that An example would be projects supporting participa- persons with disabilities face in accessing larger proj- tory decision making and community empowerment. ect objectives. Where projects have not considered disability inclusion issues in the original design, trust ­ • Projects working toward improving sanitation and funds can be useful resources to support targeted hygiene behaviors. activities to benefit persons with disabilities. • Development of rural irrigation facilities with a direct intent to increase rural employment. This includes 4.2.1.2 Safeguard Policies projects supporting on-farm water management and Safeguard processes can be used to assess risks for per- agricultural productivity activities. sons with disabilities and develop effective mitigation strategies. The key entry points for disability inclusion • Flood and watershed management projects that for borrowing governments in the World Bank’s safe- address physical environments at the household guards process include the following: level, structuring community and household envi- ronments for resilience, wastewater collection and Social impact assessments. Social impact assessments reuse infrastructure, and land use. can identify the key social risks and potential project 38 Including Persons with Disabilities in Water Sector Operations benefits for persons with disabilities. The assessments may not be able to use phone-based hotlines will include the socioeconomic status of persons with independently without access to an interpreter or ­ disabilities, and explore the potential impact of water teletyping services, which are rare in low- and mid- ­ projects on their access to resources, livelihoods, and dle-income countries. Hotlines should be offered in resettlement needs. Recommendations can address alternative formats, including providing a number for risk mitigation measures and mechanisms to reduce SMS, instant messaging communications, and e-mail. any disparity in project benefits for persons with and Information about grievance mechanisms must be dis- without disabilities. Persons with disabilities should seminated in multiple and accessible formats as well. be a target group in desk reviews and included in sur- 4.2.1.3 Environmental and Social Framework veys, consultations and focus group discussions, stakeholder meetings, and field observations. The new Environmental and Social Framework (ESF), starting in 2018, is an important milestone for promot- OP 4.12 Involuntary Resettlement. It is important for ing greater inclusion of persons with disabilities in borrowing governments to include explicitly persons financing projects. The ESF lays out more require- with disabilities and their families as an affected group ments than the current safeguard policies, to ensure in developing resettlement policies, strategies, and that persons with disabilities are protected from specific plans. As discussed in section 2.6, the usual negative impacts and included in mitigation plans ­ practices may fall short in appropriately compensating and  actions. Borrowing governments will need to and supporting households with family members with include disability as part of the social assessment. ESF disabilities, if their specific needs are not identified or addresses the need for disability inclusion and accessi- considered. The impacts covered should include the bility in consultations and communications. Borrowers loss of accessible housing and community services, are expected to provide inclusive working conditions, long-term disruptions to schooling, additional out-of- including reasonable measures to adapt workplaces, pocket expenses as compared with households with- for persons with disabilities. Project information must out persons with disabilities, and long-term ruptures be provided in a manner that is accessible to persons in employment and social networks. Housing sites pro- with disabilities. vided to displaced families should be accessible. When cash compensation is offered, calculations should 4.2.2 Development Policy Financing account for the additional expenses borne by persons Development Policy Financing is an important with disabilities. entry  point for disability inclusion. As per OP 8.60, Development Policy Financing, “in carrying out OP 4.10 Indigenous Peoples. Indigenous persons with ­dialogue with a Member Country, the Bank advises it to disabilities can face double discrimination and mar- consult with and engage the participation of key stake- ginalization due to their disability and indigenousness. holders in the country in the process of formulating its Activities conducted when OP 4.10 is triggered can development strategies.” Task teams supporting bor- include an examination of project impacts on indige- rowing countries can promote and help facilitate the nous persons with disabilities and address these in inclusion of persons with disabilities, DPOs, and other mitigation plans and measures. relevant stakeholders in consultations, citizen engage- Grievance mechanisms. Methods to record grievances ment, and other participatory activities undertaken in must be accessible to persons with disabilities. This the formulation of development strategies and policy includes providing multiple and alternative means of and institutional actions. This can include developing communication. For example, persons who are deaf disability-inclusive national development plans for Including Persons with Disabilities in Water Sector Operations 39 implementing the SDGs. Including persons with impacted and barriers and facilitators in access to disabilities and their representatives in citizen engage- ­ water resources; socioeconomic impacts on lack of ment activities will inform and impact the design of access for persons with disabilities; and political reforms, implementation processes, and development economy analysis. of disability-inclusive M&E mechanisms. • Capacity-building activities for all stakeholder groups, including government officials, develop- 4.2.3 Program-for-Results Financing ment practitioners, WASH facilitators and engi- Disability inclusion in program-for-results financing neers, persons with disabilities, DPOs, and other can be done in two ways: (i) targeting and including civil society members. See section 3.5. persons with disabilities as beneficiaries in the ­program results, and (ii) ensuring that social and environmental • Connecting clients with international experts and assessments and technical assessments consider the knowledge products. needs, challenges, and impacts on persons with dis- • Knowledge-sharing events, including peer-to-peer abilities. Program-for-results financing can be used to networks, conferences, and seminars. support behavioral interventions and changes, gover- nance reforms, improved service delivery, building • Conducting access audits and assessments of physi- accessible WASH facilities, and capacity building of cal and social environments. See section 3.6.1. government practitioners, engineers and practitioners, • Advising countries on developing or adapting acces- and other stakeholders. sibility design standards. See section 3.6. 4.3 Advisory Services and Analytics • Developing technical specifications for water access points and WASH facilities, guides, and manuals for Advisory services and analytics can be used widely to developers and practitioners. See section 3.6.3. support disability inclusion in water operations. This includes technical assistance, reimbursable advisory • Developing indicators for assessing the results and services, and economic and sector work. impacts of water operations on persons with disabil- ities. See section 3.9. Examples of services for mainstreaming disability into water operations include the following: Note • Analytical work, including desk reviews of poli- 1. M. B. Das, 2016, “Social Inclusion in Macro-Level Diagnostics. cies and practices in inclusive water operations at Reflecting on the World Bank Group’s Early Systematic Country Diagnostics,” Policy Research Working Paper 7713, http://­ the country, regional, and global levels; primary documents​.worldbank​.org/curated/en/361801467991929675/pdf​ data collection to assess how many households are /­WPS​7 713​.pdf. 40 Including Persons with Disabilities in Water Sector Operations Appendix A Resources Design Guides and Manuals Toolkits AusAid (Australian Agency for International Jones, H., and J. Wilbur. 2014. Compendium of Development). 2013. Accessibility Design Guide: Accessible WASH Technologies. Water, Engineering and Universal Design Principles for Australia’s Aid Program. Development Centre, WaterAid, and Share. http:// A companion volume to Development for All: Towards a w w w.w at e r a i d .o rg /w h at-we - d o/o u r - a p p r o a c h​ Disability-Inclusive Australian Aid Program 2009–2014. /­r esearch​-and-publications/view-publication?id​ AusAID, Canberra, Australia. http://dfat.gov.au​/­about​ =aff6d098​-00f2​-42e5-b9a0​-22ec2b264a5e. -us/publications/Documents ​ /accessibility​ - design​ National AgrAbility Project. The Toolbox: Agricultural -guide.pdf. Tools, Equipment, Machinery & Buildings for Farmers Guzmán, N., S. Huuhtanen, H. Katsui, N. Kilpelä, and Ranchers with Physical Disabilities. http://www​ M. Koistinen, K. Pesola, and T. Tuure, “Inclusive WASH .agrability.org/toolbox/. Activities in the Global South (a Guidebook).” https:// WEDC (Water, Engineering and Development Centre). www.vammaiskumppanuus.fi/wp-content​/­u ploads​ Accessibility and  Safety Audit Tools. https://wedc​ /2016/05/Inclusive_WASH_Activities_in_the_Global​ -knowledge​.lboro​.ac.uk/collections​/­equity​-­inclusion​ _­South.pdf. /­general.html. Handicap International. “How to Build an Accessible Informational Videos Environment in Developing Countries.” Manual #2: Access to Water and Sanitation Facilities. Handicap WaterAid. Count Me In: Partnering with the Arts to Get International, Silver Spring, MD. http://www​.addc.org​ the Message Out about Inclusive WASH. Series of short .au/content/resources/how-to-build-an ​ - accessible​ animated videos to raise awareness of inclusive water -environment-in-developing-countries-manual​ sector operations. Made in Cambodia. http://www​ -part-2/667/. .wateraid.org/news/blogs/2016/july/count-me-in​ -­p artnering​-w ith-the-arts-to -get-the-message​ UNICEF (United Nations Children’s Fund). 2012. -­out-about​-inclusive-​wash. “Disabilities: WASH: Listing of Resources on Making WASH Facilities Accessible.” UNICEF, New York. • How to do an accessibility and safety audit: https:// https://www.unicef.org/disabilities/index_65839.html. youtu.be/f5VEqukqZw8?list=PLc-oawSTlDS2ht3B​ _Es7​MEr3acVo8geV3. World Bank. 2008. Design for All: Implications for World Bank Operations. Report Number AGP125, volume 1. • How to do a barrier analysis: https://youtu​ World Bank, Washington, DC. http://­sit​eresources​ . b e /4 m j R px 8 AQ Rc ? l i s t = P L c - o aw S T l DS 2 ht 3 B​ .worldbank.org/DISABILITY/Resources/Universal​ _Es7MEr3acVo8geV3. _­Design​.pdf. • How to identify people with disabilities: https:// youtu.be/f1Ulyhf7ghs?list=PLc-oawSTlDS2ht3B​ WEDC (Water, Engineering and Development Centre). _Es7MEr3acVo8geV3. Equity and Inclusion in Water, Sanitation and Hygiene. Various resource materials. https://wedc-knowledge​ • How to partner with a DPO: https://youtu​ .lboro.ac.uk/collections/equity-inclusion​ /­g eneral​ . b e /3 U r 7 RT O 5 H E c ? l i s t = P L c - o aw S T l DS 2 ht 3 B​ .html. _Es7MEr3acVo8geV3. Including Persons with Disabilities in Water Sector Operations 41 SKU W17041