People with disabilities are more likely to experience poverty and vulnerability because they face additional costs. For this reason, a social protection system that has a scheme specifically for people with disabilities is key for an equal society, in which everyone can have the chance of a good quality of life. In Kenya, the government provides cash transfers to people with disabilities; however, this targets people with severe disabilities only, often inaccurately excluding many potential beneficiaries and leaving them without the funds they need to pay the additional costs of living with a disability.
While there are many types of costs, in this blog I cover the most basic factors – health, transport, housing, education and missed income opportunities.
To appreciate the increased cost of living for people with disabilities, we first have to understand the two spheres: impairment and disability, and how they differ from one another:
- The first sphere is the impairment itself: the health and physical conditions of people with disabilities. This can include physical, intellectual, sensory, or mental impairments according to the United Nations Convention on the Rights of Persons with Disabilities (UNCRPD).
- The second sphere is disability: an evolving concept resulting from the ‘interaction between people with impairments and attitudinal and environmental barriers that hinders their full and effective participation in society on an equal basis with others’ (UNCRPD). People with impairments incur additional costs simply due to the barriers they face in their socio-physical environment.
In addition to these two spheres, Palmer (2015) identifies forgone benefits due to disability as an additional cost: the missed income opportunities of individuals or their carers who are unable to work or work less due to disability. The sum of the costs resulting from the two spheres plus the forgone benefits reflects the true additional cost of living to people with disabilities.
Healthcare
Healthcare is a requirement that increases the cost of living to people with disabilities in both spheres. First, the cost of health consultations, medication and care are part of the impairment sphere. For people in many places in Kenya, health centres are far away. Long-distance travel and accommodation for a day or two in major towns are therefore costs incurred in the disability sphere: for my therapy sessions, I used to attend a hospital around 200 kilometres from home and my mother would have to budget for transport and accommodation.
In addition, assistive devices such as prostheses are expensive and require a lump sum payment. For instance, here in Kenya, prosthesis limbs and wheelchairs cost a relatively large amount: up to 360,000 Kenyan shillings (over 3,000 US dollars). On top of that, recurring costs such as electricity for charging electric wheelchairs continue to hit people unable to walk. Then there are often additional costs that cannot be planned for; for example right now my prostheses urgently need repairing, which could cost 30,000 Kenyan shillings (over 250 US dollars).
Transport services
People with disabilities incur additional transport costs, especially in the Global South where transport infrastructure is not always well developed. These costs are a result of the ‘disability’ sphere. This was an issue for my family particularly in the early stages of my disability when I was a child. We had to hire a taxi from our rural area to get to the hospital because of inaccessible road networks. And it continues to be the case now: I can’t get about without the services of motorcycle taxis where the terrain is rough in bad weather.
Misconceptions surrounding disabilities can even result in additional costs, especially in areas where there is limited knowledge about disabilities. For instance, when I was younger, my mother would have to pay for an extra seat on buses because some travellers refused to sit next to a person with a disability.
Housing
Housing is a basic human need, and decent housing is expensive for some people with disabilities because adaptations are needed. Taking Kenya as an example, pit latrines are the most common type of toilet and are customary in cheaper housing. However, people with some types of physical impairments need flush toilets so that they can sit, which means paying higher rent for more expensive housing and higher water bills. These adaptations impose a cost on people as a result of built environment norms, or the ‘disability’ sphere.
Education
Illiteracy rates in people with disabilities are high (Banks et al, 2017). This is generally because of the high cost of accessible education to people with disabilities. Kenya has free primary and secondary schools for all, but this is not the case for children who need additional support; they need to go to different fee-paying schools. My disability did not allow me to join a free secondary school so I had to attend a special school which was expensive. Were it not for a scholarship which covered my secondary school education fee, attending school would have been ruled out.
In some places there are no schools for people with disabilities. In these cases, families for people with disabilities have to hire private tutors, which are extremely expensive. In addition to the cost of education, people with disabilities incur additional costs of learning outside of school. To facilitate my study at home, my mother had to buy a desk high enough for me as I could no longer use the normal low table used by my siblings.
Missed income opportunities
The cost of missed income from the lack of job opportunities is significant to people living with disabilities. In my own example, my mother, who was a casual labourer, made a loss each time I attended hospital. Beyond that, in some instances, my elder brother had to miss school himself to take me to hospital as my mother had to go to work to get paid.
Inclusive social protection policies for a better life for people with disabilities
People with disabilities experience an array of increased costs to their daily lives as well as forgone benefits, resulting from both spheres: their impairment and disability. The additional cost of living can have huge implications on their finances, wellbeing and quality of life – for some people these costs can even lead to poverty. This is often caused by socio-physical limitations – the disability sphere – rather than the impairment itself. Social protection is a strong mechanism for easing the burden of additional costs and for preventing people from falling into poverty.
We need to improve people’s understanding of the additional costs faced by people with disabilities. Only with this understanding will there be a shift to better, more effective, disability-inclusive social protection policies in Kenya and beyond.
References
Palmer M., Groce N., Mont D., Nguyen O. H., Mitra S. (2015). The Economic Lives of People with Disabilities in Vietnam. PLoS ONE. Retrieved from https://doi:10.1371/journal.pone.0133623 on 12/02/2022
Groce et al. (2011). Disability and Poverty: The Need for a More Nuanced Understanding of Implications for Development Policy and Practice. Taylor & Francis, Ltd. Retrieved from https://www.jstor.org/stable/41300297 on 31/12/2021.
Banks, L. M., Kuper, H., & Polack, S. (2017). Poverty and Disability in Low- and Middle-Income Countries: A Systematic Review. PLoS ONE. Retrieved from https://doi.org/10.1371/journal.pone.0189996 on 31/12/2021
United Nations. (2008). United Nations Convention on the Rights of Persons with Disabilities.