Targeting social protection for people with disabilities
Creators: name: Palmer, Michael George
Publisher: name: The Australian National University
Year: 2010
Subjects: subject: HV1559.V5 P35 2010
subject: People with disabilities Social conditionsVietnam
subject: Social rights

description: People with disabilities (PWDs) are over-represented among the world's poor and under-represented in programs of direct poverty alleviation. Including them in the latter is important to achieving the UN Millennium Development Goals of eradicating world poverty and hunger. The international Convention on the Rights of People with Disabilities (CRPD) identifies the right to an adequate standard of living and social protection as equal among all other rights. In order to design and evaluate such interventions it is necessary to gain a better understanding of the relation between disability and poverty. This thesis examines the economic impact of disability and public programs of social protection in Vietnam. Vietnam is a suitable case study for several reasons. First, the country has a large disabled population due to war and low national income. Second, the country has relatively good disability data. Third, the country has an elaborate legal and administrative framework for the social protection of PWDs and other vulnerable groups. Data were drawn from the Vietnam National Health Survey 2001-02 and an epidemiological surveillance site in northern Vietnam, called the CHILILAB. The field study included a quantitative survey of the disabled site population (n=11,214) and qualitative interviews with 27 households with disabled members. Severity of disability was positively associated with poverty and health expenditures were a significant economic burden for households with severely disabled members. These findings were confirmed by analysis of the national health survey which adopted a measure of severe disability (n=4,905). Households with disabled members were at a greater risk of catastrophic health expenditures and debt-financing, posing a serious threat to long-term household welfare. Government programs of income and health care support were low in coverage and formulated at a high level of generality. Cash transfers were insufficient to cover minimum daily food intake while health insurance provided protection against low-grade outpatient expenditures but was insufficient for costs of inpatient care and drugs. Analysis of national health survey data confirmed that community-based targeting was ineffective and insurance mechanisms were an inadequate buffer for inpatient costs. The Government has recently tried to extend programs of social protection to households with severely disabled members. However, a higher level of disability targeting is required, both in terms of eligibility and level of benefits. Eligibility may best be determined by the district social security office using definitions to identify an eligible subpopulation sufficiently small to provide universal coverage for all economic costs of disability. Alternatively, coverage of all health expenses with some cost sharing is preferable to current low benefit ceilings that leave PWDs bearing too much risk. This thesis fosters new thinking on the role of social protection in developing countries. Drawing on the available theory and evidence, it advocates social protection for PWDs as a human right with important externalities to economic and social inclusion.