Street-level challenges to determining eligibility for disability-related social assistance in African countries
(University of Cape Town)
Paper short abstract:
This paper considers the implementation of cash transfer programmes for disabled persons in Africa, with a particular focus on Zambia and South Africa.
Paper long abstract:
Previously neglected in social assistance programming in African countries, there is growing interest from donor institutions and governments in developing disability-inclusive social protection in Africa, either through categorical targeting or including them in mainstream cash transfer schemes. Accurately targeting disabled people for disability benefits is notoriously difficult, particularly in low-resource contexts, largely because of the administrative complexities of assessing the existence and severity of disability. This paper details and critiques the models and methods used to assess eligibility in existing programmes on the continent. It focuses particularly on the cases of Zambia and South Africa to illustrate some of the street-level challenges of disability determination, which are influenced both by policy design and implementation context. Both countries have experimented with multiple models of assessment, but eligibility is currently based on the findings of medical officers, who have significant discretion in interpreting and applying eligibility criteria, leading to inconsistencies in practice and inclusion and exclusion errors. Unpacking these challenges provides learnings for the development of such programmes in Africa and highlights the important role that frontline workers play in shaping social policy implementation.
Social Assistance Policies in Africa