Protocol for a Systematic Review: Interventions to Improve the Labour Market Situation of Adults with Physical and/or Sensory Disabilities in Low‐ and Middle‐Income Countries

Abstract

Disability is a key development issue. Recent estimates suggest that more than one billion people (or about 15% of the world’s population) are living with some form of disability (World Health Organization [WHO], 2011). Of this total, 80% live in developing countries, according to the UN Development Programme (UNDP). Disability and poverty are complex, dynamic, and intricately linked phenomena, with the result that disabled people are overrepresented among the world’s poor, and many experience multiple deprivations at higher rates and in higher breadth, depth, and severity than people without disabilities (Mitra, Posarac, & Vick, 2013; Samman & Rodriguez-Takeuchi, 2013). Low rates of employment among disabled persons are one of the principal pathways through which disability may lead to poverty (Braitwaite & Mont, 2009; Haveman & Wolfe, 1990; Hoogeveen, 2005; Peiyun & Livermore, 2008; Zaidi & Burchardt, 2005). Employment is, therefore, considered a key factor in the process of empowerment and inclusion into society for people with disabilities (Department for International Development [DFID], 2000). The Millennium Development Goals (MDGs) on eliminating poverty, launched by the United Nations in 2000, are unlikely to be achieved unless action is taken to support disabled people’s participation in the labour market. Over the course of the last 30 years, the conceptualisation of disability has moved from an individual perspective in which disability was simply expressed as a medical condition, to a structural, social perspective in which individuals are viewed as being disabled by society rather than their bodies (Barnes & Mercer, 2010; Oliver, 1990). Although defining disability remains complex and controversial, the International Classification of Functioning, Disability and Health (ICF), which was developed through a long process involving academics, clinicians, and—importantly—disabled persons, has further advanced the understanding and measurement of disability (WHO, 2001). Representing a workable compromise between medical and social models, the ICF understands disability as arising from the interaction of health conditions with contextual factors (both environmental and personal). Disability is thus viewed not as a static feature of an individual, but rather as a complex, multi-dimensional, and changing experience for the individual (Schneider & Hartley, 2006). Widely used by researchers and policy makers when addressing disability issues in the global development literature, the ICF is adopted as the conceptual framework for this systematic review. Despite the ICF, a lack of standardisation in disability statistics and definitions continues. While reliable data on the employment of people with disabilities worldwide is difficult to come by, a growing body of empirical evidence indicates that employment participation rates for disabled people are below that of the overall population; and when disabled people do work, they generally do so for longer hours and lower incomes, have fewer chances of promotion, are more likely to work in the informal labour market, and are at greater risk of 3 The Campbell Collaboration | www.campbellcollaboration.org becoming unemployed for longer periods (Coleridge, 2005; Contreras, Ruiz-Tagle, Garces, & Azocar, 2006; Houtenville, Stapleton, Weathers, & Burkhauser, 2009; Mete, 2008; Mitra, 2008; Mitra et al., 2013; Mitra & Sambamoorthi, 2006; Mizunoya & Mitra, 2012; Roulstone, 2012; Roulstone, Gradwell, Price, & Child, 2003). The costs of disability are particularly acute in low- and middle-income countries (LMICs), where it is estimated that in some countries 80% of people with disabilities of working age are unemployed, around twice that for disabled people in industrialised countries (Contreras et al., 2006; Groce, Kembhavi, Wirz, Lang, Trani, & Kett, 2011; Houtenville et al., 2009; International Disability Rights Monitor, 2004; Mete, 2008; Mitra, 2008, 2009; Mitra et al., 2013; Organisation for Economic Cooperation and Development [OECD], 2010). It is less clear whether the wage gap between disabled and non-disabled persons is as marked in developing counties as it is in industrialised countries (Mitra & Sambamoorthi, 2006, 2008, 2009; OECD, 2003; WHO, 2011). However, the disability experience varies greatly. While disability correlates with disadvantage, not all people with disabilities are equally disadvantaged. In practice, the extent of the negative effect of disability on employment will vary depending on a variety of factors (Goertz, van Lierop, Houkes, & Nijhuis, 2010; Ingstad & Reynolds-Whyte, 1995; Kidd, Sloane, & Ferko, 2000; Mitra et al., 2013; OECD, 2010; Sena-Martins, 2010; World Bank, 2009). These include personal factors such as age, sex, level of education, motivation to work, and lack of financial resources. For instance, women with disabilities are recognised to be multiply disadvantaged, experiencing exclusion on account of their gender and their disability. There is evidence that disabled women tend to have poorer access to jobs, lower employment rates, and considerably lower earnings than male peers in similar jobs (Emmett, 2006; Mitra & Sambamoorthi, 2006; Mitra et al., 2013). People with more severe impairments often experience greater disadvantage in the labour market; the links between disability and employment have also been shown to vary across disability types and duration (WHO, 2011; World Blind Union, 2004). Secondly, the effects of disability on employment depend on various environmental factors, including the physical accessibility of local workplaces and transport facilities, available accommodations, and social attitudes (Baldwin & Johnson, 2006; Bound & Burkhauser, 1999; Mitra & Sambamoorthi 2008). There is also some evidence that disabled people seeking to access and sustain employment in competitive, tight labour markets are disadvantaged (Mitra, 2009). The policy context is relevant, too. The particular educational facilities, employment supports, health services, disability benefit systems, and other interventions, available in a given context can influence whether, and to what extent, disability has employment consequences.