UNIVERSITY OF GHANA COLLEGE OF HUMANITIES EXPLORING ACCESSIBILITY TO AND USES OF THE DISABILITY SUPPORT FUND AMONG PERSONS WITH DISABILITY (PWDS) IN THE NSAWAM ADOAGYIRI MUNICIPALITY BY DAHANATU SALIFU (10874925) THIS DISSERTATION IS SUBMITTED TO THE UNIVERSITY OF GHANA, LEGON, IN PARTIAL FULFILMENT OF THE REQUIREMENT FOR THE AWARD OF MA IN DEVELOPMENT STUDIES DEGREE INSTITUTE OF STATISTICAL, SOCIAL AND ECONOMIC RESEARCH NOVEMBER, 2022 University of Ghana http://ugspace.ug.edu.gh i DECLARATION I hereby declare that except for the references to other authors’ works, which have been duly acknowledged, this dissertation “Exploring Accessibility to and Uses of the Disability Support Fund Among Persons With Disability (PWDs) in the Nsawam Adoagyiri Municipality” is my own research work carried out in the Institute of Statistical, Social, and Economic Research (ISSER) under the supervision of Dr. Cynthia Addoquaye Tagoe. 30/11/22 …………………………………………… ……………………………….. DAHANATU SALIFU DATE (STUDENT) 30/11/22 …………………………………………… ……………………………….. DR. CYNTHIA ADDOQUAYE TAGOE DATE (SUPERVISOR) University of Ghana http://ugspace.ug.edu.gh ii ABSTRACT Persons with Disability (PWDs) are said to be the poorest in the global and Ghanaian economy. This issue is worrisome particularly when several of these persons are found among the poorest of the poor and may also suffer deprivations of lack of access to economic and social services in Ghana. The Disability Support Fund (DSF) was thus initiated as a social protection response to address poverty among PWDs and their households. The Disability Support Fund notwithstanding is faced with accessibility challenges. This study investigated the accessibility to and uses of the DSF among PWDs in the Nsawam Adoagyiri Municipality using cross-sectional design with a mixed-method approach. The study employed a total sample of 150 PWDs with three key informants from the DSF Management Committee including the chairperson, finance secretary and the PWDs’ representative using a questionnaire and an interview guide respectively. The study revealed that the DSF has been useful in terms of contributing to the livelihoods of PWDs in the Nsawam Adoagyiri Municipality. Beneficiaries were able to fund their education, food and healthcare with the help of the Fund. Though useful, a significant number (about 70%) of PWDs in the municipality did not have access to the Fund due to the insufficiency of the Fund. For this reason, the contribution of the Fund to the livelihoods of PWDs in the Nsawam Adoagyiri Municipality appeared to be significantly marginal. There were delays in the disbursement of the Fund from the central government and the municipal office due to some stringent procedures required to follow before amounts are disbursed. The study recommends that the government provides enough funding at the MMDAs and for that matter the Department of Social Welfare to enable them disburse adequate funds to all qualified PWDs. Additionally, the support of NGOs, firms, and philanthropic individuals through financial and material support to the Fund could increase the Fund and also help improve the accessibility of the Fund by PWDs. University of Ghana http://ugspace.ug.edu.gh iii DEDICATION This work is dedicated to Allah, the All-Powerful, who has blessed me with knowledge, wisdom, health, and strength throughout my academic career. University of Ghana http://ugspace.ug.edu.gh iv ACKNOWLEDGEMENT First and paramount, I want to express my gratitude to Almighty Allah for all of the blessings He has bestowed upon me during my years of education. Secondly, I would like to give a heartfelt gratitude to Dr. Cynthia Addoquaye Tagoe, my supervisor, for providing me with the motivation, direction, and thorough feedback that helped me finish this project. Special appreciation goes to Mr. Emmanuel K. T. Aboagye of World Vision Ghana, Dr. Eric Koka of University of Cape Coast and Dr. Fred Dzanku of ISSER for their unflinching support. Special thanks to Mr. Emmanuel Narh, Mr. John Abuga, Mr. Issah Musah Aziba, Mr. Karim Wupini and Mr. Evans Ewudzie for their support. I am eternally grateful to my family and friends for their unwavering support throughout my academic career. Mrs. Christiana Tamakloe, my boss, deserves credit for providing me with the motivation I needed to begin and complete this course. The support of the Nsawam Adoagyiri Municipal Assembly and all study participants is greatly appreciated. Finally, I would like to express my heartfelt gratitude to every professor, co-worker, and individual who assisted me in getting started on this research project. University of Ghana http://ugspace.ug.edu.gh v TABLE OF CONTENTS DECLARATION............................................................................................................................ i ABSTRACT ................................................................................................................................... ii DEDICATION.............................................................................................................................. iii ACKNOWLEDGEMENT ........................................................................................................... iv TABLE OF CONTENTS ............................................................................................................. v LIST OF FIGURES ...................................................................................................................... x LIST OF TABLES ....................................................................................................................... xi LIST OF ACRONYMS .............................................................................................................. xii CHAPTER ONE: INTRODUCTION ......................................................................................... 1 1.0 Background of Study .................................................................................................................. 1 1.1 Problem Statement ...................................................................................................................... 6 1.2 Research Questions ........................................................................................................................... 8 1.3 Research Objectives .......................................................................................................................... 8 1.4 Significance of the Study .................................................................................................................. 8 1.5 Limitation to Study ........................................................................................................................... 9 1.6 Definition of Concepts/Terms ........................................................................................................ 10 1.6.1 Welfare/Well-being .................................................................................................................. 10 University of Ghana http://ugspace.ug.edu.gh vi 1.6.2 Persons with Disability (PWDs) .............................................................................................. 10 1.6.3 Assistive Devices ....................................................................................................................... 11 CHAPTER TWO: LITERATURE REVIEW .......................................................................... 13 2.0 Introduction ............................................................................................................................... 13 2.1 The Concept of Disability ............................................................................................................... 13 2.1.1 Disability Classification and Models ...................................................................................... 14 2.1.2. Disability and Vulnerability ................................................................................................... 16 2.2 Concept of Social Protection .......................................................................................................... 19 2.2.1 Social Assistance ........................................................................................................................... 22 2.2.2 Social Insurance ....................................................................................................................... 22 2.2.3 Transformative Social Protection ........................................................................................... 23 2.3 International Instruments on Social Protection ........................................................................... 23 2.3.1 Universal Declaration of Human Rights ................................................................................ 23 2.3.2 International Labour Organisation’s Conventions on Social Security ............................... 25 2.3.3 Convention on the Rights of Persons with Disabilities ......................................................... 25 2.4 Social Protection and Vulnerability Reduction ............................................................................ 27 2.5 Access and Impact of Social Assistance Interventions in Africa ................................................ 28 2.6. State of Disability and Social Protection in Ghana ..................................................................... 30 2.7 The Disability Support/Common Fund ......................................................................................... 31 2.7.1. Accessibility of the Disability Support Fund to PWDs in Ghana ....................................... 32 2.7.2 Effects of Disability Support Fund on PWDs ........................................................................ 34 University of Ghana http://ugspace.ug.edu.gh vii 2.7.3 Challenges in managing Disability Support Fund ................................................................ 35 2.8 Theoretical Framework .................................................................................................................. 36 2.9. Conceptual Framework ................................................................................................................. 41 CHAPTER THREE: RESEARCH METHODOLOGY ......................................................... 45 3.0 Introduction ..................................................................................................................................... 45 3.1 Profile of the Study Area ................................................................................................................ 45 3.2 Research Design and Approach ..................................................................................................... 47 3.3 Data Sources .................................................................................................................................... 48 3.4 Study Population and Sample Size ................................................................................................ 48 3.5 Sampling Procedure ........................................................................................................................ 49 3.6 Data Collection ................................................................................................................................ 51 3.7 Data Analysis ................................................................................................................................... 52 3.8 Ethical Consideration ..................................................................................................................... 54 3.9 Study Limitations ............................................................................................................................ 54 CHAPTER FOUR: DATA ANALYSIS AND DISCUSSION ................................................. 55 4.0 Introduction ............................................................................................................................... 55 4.1 Demographic Characteristics of Respondents.............................................................................. 55 4.1.1 Sex of Respondents................................................................................................................... 55 4.1.2 Age of Respondents .................................................................................................................. 57 4.1.3 Marital Status of Respondents ................................................................................................ 58 4.1.4 Respondents’ Level of Education ........................................................................................... 59 University of Ghana http://ugspace.ug.edu.gh viii 4.1.5 Occupation of Respondents ..................................................................................................... 60 4.1.6 Disability Associations of Respondents .................................................................................. 61 4.1.7 Number of Disabilities Suffered by Respondents .................................................................. 62 4.1.8. Stage of Life Respondents Became PWDs ............................................................................ 63 4.1.9 Types of Disabilities Respondents Suffer ............................................................................... 64 4.1.10 Assistive Devices Used by Respondents................................................................................ 65 4.1.11 Assistive Devices Provided by the Fund ............................................................................... 66 4.2 Financial Obligations on Respondents .......................................................................................... 67 4.2.1 Dependants of Respondents .................................................................................................... 67 4.2.2 Responsibility of Respondents Regarding their Dependants ............................................... 68 4.2.3 Respondents’ Monthly Income Levels ................................................................................... 69 4.3 PWDs’ Level of Awareness of the Disability Support Fund ....................................................... 77 4.4 Accessibility of the Disability Support Fund to PWDs ................................................................ 82 4.4.1 Factors Affecting Access to and Approval of DSF Application ........................................... 84 4.4.2 Forms of Support Received by Respondents ......................................................................... 85 4.4.3 Frequency of Support Received by Respondents from the Fund since 2017 ...................... 88 4.4.4 First-Time Respondents Received Support from the Fund ................................................. 89 4.5 Challenges ........................................................................................................................................ 90 4.5.1 Forms of Discrimination Respondents Encounter ................................................................ 90 4.5.2 Joining Queues to Access the Fund’s Office .......................................................................... 91 4.5.3 Average Waiting Time of Respondents at the Fund’s Facility ............................................ 92 4.5.4 Respondents’ Rating of the Treatment Receive at the Fund’s Office ................................. 92 University of Ghana http://ugspace.ug.edu.gh ix 4.5.5 Rating of the Attitude of Officers in the Support Fund Offices........................................... 93 4.6 Measures to Protect and Promote the Rights of Respondents .................................................... 94 4.7 Effects of the Disability Support Fund on the lives of PWDs ..................................................... 95 4.7.1 Opinions of PWDs on the usefulness of the Disability Support Fund ................................. 95 4.7.2 Area(s) of the Lives of PWDs that the Fund Supports ......................................................... 96 4.8 Management of the Support Fund ................................................................................................ 98 4.8.1 Monitoring of the Utilisation of the Support Fund by the Management Committee ........ 98 4.8.2 Feedback Received from the PWDs on Support Received from the Fund ......................... 99 4.8.3 Major Challenges observed by the Committee in the Disbursement of the Fund ........... 100 4.8.4 Forms of Social Insurance Provided to PWDs by the Fund ............................................... 102 CHAPTER FIVE: SUMMARY OF FINDINGS, CONCLUSIONS AND RECOMMENDATIONS .......................................................................................................... 103 5.0 Introduction ................................................................................................................................... 103 5.1 Summary of Findings ................................................................................................................... 103 5.2 Conclusion ..................................................................................................................................... 105 5.3 Recommendations ......................................................................................................................... 106 REFERENCES .......................................................................................................................... 108 APPENDIX A: QUESTIONNAIRE ........................................................................................ 125 APPENDIX B: INTERVIEW GUIDE .................................................................................... 134 University of Ghana http://ugspace.ug.edu.gh x LIST OF FIGURES Figure 2.1: Conceptual Framework ............................................................................................................ 44 Figure 3.1: Map of Nsawam Adoagyiri Municipality ................................................................................. 47 Figure 4.1: Sex of Respondents .................................................................................................................. 56 Figure 4.2: Age of Respondents .................................................................................................................. 57 Figure 4.3: Marital Status of Respondents .................................................................................................. 58 Figure 4.4: Educational Level of Respondents ........................................................................................... 60 Figure 4.5: Occupation of Respondents ...................................................................................................... 61 Figure 4.6: Respondents who Ever Applied for the Fund ........................................................................... 82 Figure 4.7: Receipt of Disability Fund upon First Application .................................................................. 83 Figure 4.8: The Year First Support was Received ...................................................................................... 84 Figure 4.9: Forms of Support Received by Respondents ............................................................................ 86 Figure 4.10: Cash Support Received by Respondents ................................................................................ 86 Figure 4.11 Support Received in Kind by Respondents ............................................................................. 87 Figure 4.12: Frequency of Support Received by Respondents ................................................................... 88 Figure 4.13: First-Time Respondents Received Support from the Fund .................................................... 90 Figure 4.15: Average Waiting Time of Respondents.................................................................................. 92 Figure 4.16: Respondents Rating of the Treatment Received at the Fund’s Office .................................... 93 Figure 4.17: Rating of the Attitude of Officers in the Support Fund Office ............................................... 94 Figure 4.18: Opinions of PWDs on the Usefulness of the Disability Support Fund ................................... 96 University of Ghana http://ugspace.ug.edu.gh xi LIST OF TABLES Table 3.1: Population of PWDs .................................................................................................... 50 Table 3.2: Sample Size Determination ......................................................................................... 50 Table 3.3: Summary of Objectives and Key Variables of Interest ............................................... 53 Table 4.1: Disability Associations of Respondents ...................................................................... 62 Table 4.2: Number of Disabilities Suffered by Respondents ....................................................... 63 Table 4.3: Stage of Life Respondents Became PWDs .................................................................. 64 Table 4.4: Types of Disabilities Respondents Suffer.................................................................... 65 Table 4.5: Assistive Devices Used by Respondents ..................................................................... 66 Table 4.6: Assistive Devices Provided by the Fund ..................................................................... 67 Table 4.7: Number of Respondents’ Dependants ......................................................................... 68 Table 4.8: Responsibility for Respondents’ Dependants .............................................................. 68 Table 4.9: Monthly Income Level of Respondents ....................................................................... 70 Table 4.10: Cross Tabulation of Monthly Income Level and Occupation of Respondents .......... 72 Table 4.11: Monthly Expenditure on Healthcare .......................................................................... 74 Table 4.12: Daily Expenditure on Food ........................................................................................ 75 Table 4.13: Monthly Expenditure on Educational Needs (fees, books, transport, etc.) ............... 76 Table 4.14: Level of PWDs Access to Information on DSF ......................................................... 78 Table 4.15: Area(s) of the Lives of PWDs that the Fund Supports .............................................. 97 University of Ghana http://ugspace.ug.edu.gh xii LIST OF ACRONYMS CRPD Convention on the Rights of Persons with Disabilities DACF District Assemblies Common Fund DCF Disability Common Fund DSF Disability Support Fund GSS Ghana Statistical Service ICF International Classification of Functioning ILO International Labour Organisation LEAP Livelihood Empowerment Against Poverty MDGs Millennium Development Goals MMDAs Metropolitan, Municipal and District Assemblies MMDCEs Metropolitan, Municipal and District Chief Executives NAMA Nsawam Adoagyiri Municipal Assembly NCPD National Council for Persons with Disability NGO Non-Governmental Organisation NHIS National Health Insurance Scheme OECD Organisation for Economic Co-operation and Development PWD Person with Disability PWDs Persons with Disability SDGs Sustainable Development Goals UDHR Universal Declaration of Human Rights UK United Kingdom UN United Nations University of Ghana http://ugspace.ug.edu.gh xiii UNCRPD United Nations Convention on the Right of Persons with Disabilities UNESCO United Nations Educational Scientific and Cultural Organisation UNICEF United Nations International Children’s Emergency Fund USD United States Dollars WHO World Health Organisation University of Ghana http://ugspace.ug.edu.gh 1 CHAPTER ONE: INTRODUCTION 1.0 Background of Study The World Health Organisation (2021:10), defined disability as “the outcome of the interaction between individuals with a health condition (e.g. cerebral palsy, Down syndrome or depression) and personal and environmental factors (e.g. negative attitudes, inaccessible transportation and public buildings, and limited social supports)”. The international community has made it abundantly clear through the Millennium Development Goals (MDGs) and the Sustainable Development Goals (SDGs), that it is committed to ending poverty through concerted, forward- thinking action. Most of these groups, including the World Bank, the United Nations, and other development partners, have concentrated on helping poorer countries implement pro-poor policies. Amidst this global attempt, Persons with Disability (PWDs) have been found to be worse sufferers of poverty, experiencing multiple deprivations with multidimensional poverty gaps higher than persons without disabilities (DESA, 2011). According to the World Health Organisation (2022), approximately 1.3 billion people, which accounts for 16 percent of the global population, experience significant disability. These PWDs are mostly subjected to discrimination and stigma which have effects on their mental and physical health (WHO, 2022). These limitations make them highly vulnerable and subject to various deprivations which affect their social and economic progress in society. Shakespeare et al. (2019) therefore, asserted that deprivations and inequities make PWDs non-resilient to many risks. These risks aggravate not only their poverty status but also their vulnerability due to unavailability and lack of access to economic and social resources for preventing, mitigating and coping with shocks. It is therefore necessary for PWDs to be specifically targeted in developing poverty reduction University of Ghana http://ugspace.ug.edu.gh 2 initiatives. Disability inclusion is also vital in achieving ‘health for all’ as priorities for global health and the SDGs (WHO, 2022). The realisation of targeting PWDs in developing poverty reduction initiatives which was omitted from the Millennium Development Goals (MDGs) has triggered debate towards the demand for intentional inclusion of PWDs and their needs in social protection policies and programmes at all levels (Banks et al., 2017). The Sustainable Development Goals include several targets that aim to improve the lives of PWDs and promote their inclusion and participation in society. Some of these targets include SDG 1 (Target 1.4 seeks to ensure that all men and women, especially the poor and vulnerable have equal rights to economic resources as well as basic services to reduce poverty), SDG 4 (Target 4.5 seeks to eliminate gender disparities in education and ensure equal access to all levels of education and vocational training for the vulnerable including PWDs), SDG 8 (Target 8.5 seeks to achieve full and productive employment and decent work for all women and men, including for young people and PWDs, and equal pay for work of equal value), SDG 10 (Target 10.2 seeks to empower and promote economic, social and political inclusion for all and reduce inequalities within and among countries), SDG 11 (Target 11.2 seeks to provide universal access to safe, affordable, accessible, and sustainable transport systems, particularly for women and children, older persons and PWDs) and SDG 16 (Target 16.3 seeks to promote peaceful and inclusive societies, provide access to justice for all, and build effective and accountable institutions) which all work towards improving the lives of everyone, including PWDs. In its attempt to provide a unified and standardised synopsis of wellness and health-related states of Persons with Disability, the World Health Organisation (WHO, 2011) has developed an University of Ghana http://ugspace.ug.edu.gh 3 International Classification of Functioning Disability and Health. Within this classification system, disabilities are categorised as involving one or more of the following: • Impairment: conditions that exist within the intrinsic structure of a given body such as loss or total deformity of a body part or an organ and function which restricts the ability of a person to perform everyday functions. Cleft lip, cleft palate, deafness, blindness, mental retardation, limb deformities, and stuttering are all examples. • Activity limitation: this denotes struggles that an individual may have which cause a stall or anomaly when executing daily activities such as doing housework and dressing. • Participation restrictions: which denote restrictions faced by persons in playing a part in life situations. These may be in the form of restriction faced in daily activities like climbing a staircase, walking, hearing and speaking. Therefore, it is essential to look at the functioning of an individual in terms of impairment as the consequence of a complex interplay between the individual's health concerns and the contexts that are the product of both personal and environmental factors such as sex, age, religion, ethnicity, personal attitude, limited social support and economic situation. However, the medical conditions such as blindness, cerebral palsy, dementia, down syndrome or spinal cord injury impact on the welfare of persons living with these restrictions, limitations or impairments (WHO, 2011; Banks et al., 2017; WHO, 2021; WHO, 2022). The general development response to protect all vulnerable persons in society including Persons with Disability underpins policy and actions which resulted in welfare systems and initiatives. Over time the term, well-being, has also evolved in the literature as economists strove to measure happiness and good life through utility and satisfaction (Maximo, 2016). University of Ghana http://ugspace.ug.edu.gh 4 The welfare concept which is based on earlier economic theory focused predominantly on economic power denoting that an individual’s welfare (quality of life) should be perceived and measured by one’s income. Criticisms of the welfare concept as measured narrowly by income, led to shift to the use of well-being which accommodates other subjective determinants of a good life other than income of an individual or group of people (Maximo, 2016). The term "welfare" is most commonly used within the realm of social protection; however, the scope of its measures often goes far beyond the realm of pure economics to encompass concerns such as the availability of nourishing food, medical care, and quality educational opportunities (Norton et al., 2012). The Organisation for Economic Co-operation and Development (2013) therefore averred that all definitions at least point to the fact that well-being or welfare is achieved when essential human needs are met with individuals able to pursue their life goals. In Ghana’s policy and legal space, there are several provisions which seek to protect and enhance the welfare of persons who are socially disadvantaged including PWDs. Such efforts span from its clear support of global action in the form of guidelines and frameworks such as Article 25 of the Universal Declaration of Human Rights and Article 28 of the United Nations Convention on the Rights of Persons with Disabilities treaty (International Labour Organisation, 2015). Prior to this action, the Persons with Disability Act 2006 (Act 715) which is also referred to as the Disability Act 2006 had been passed in 2006 by Ghana’s Parliament to further cushion rights of Persons with Disability. Additionally, there are crosscutting legal provisions for protecting the rights of PWDs such as Children’s Act 1998 (Act 560), the National Health Insurance Act 2012 (Act 852), the Education Act 2008 (Act 778) and the Labour Act 2003 (Act 651). These legislations have specific sections which address the needs of PWDs (Republic of Ghana, 1998; 2003; 2006; 2008; 2012). University of Ghana http://ugspace.ug.edu.gh 5 More so, as Article 29 of the 1992 Constitution of Ghana spells out the rights of PWDs, the Disability Act 2006 in particular is quite comprehensive with about 61 clauses, which touch on rights of PWDs; promising access to service, education, transportation, and health care (Republic of Ghana, 2006). Beside these substantial legal provisions, specific initiatives have been made by several governments to support the economic and social progress of PWDs. One of the specific social protection programmes introduced at the local level is the Disability Support Fund for Persons with Disability. This Fund seeks to support PWDs to enhance their social and economic development (Ghana Statistical Service, 2014a). The Disability Support Fund which was 2 percent (now 3%) allocation of the District Assemblies Common Fund (DACF) is transferred to the various Metropolitan, Municipal and District Assemblies (MMDAs) from the central government on quarterly basis (Gyamfi, 2013). The National Council for Persons with Disability (NCPD), in collaboration with other stakeholders in Ghana's social protection system, has developed a set of guidelines for the distribution of funds in addition to ensuring that these resources are utilised in the most efficient manner possible. These guidelines prioritise the following areas: raising public awareness about problems faced by PWDs; assisting PWDs in strengthening their organisations; offering PWDs access to skills training and income-generating opportunities; and facilitating their participation in formal education and the job market (National Council on Persons with Disability, 2010). It is a one-time payment with a limited opportunity for subsequent support opened to all PWDs within the various local government areas who can clearly articulate their purposes for accessing the Fund. The limited University of Ghana http://ugspace.ug.edu.gh 6 subsequent opportunity is subject to beneficiaries’ ability to show evidence of proper utilisation (Opoku & Nketia, 2021). Within the MMDAs, a five-member Management Committee is constituted to include the District Planning Officer, Social Welfare Director, and other members appointed by the MMDAs to oversee the utilisation of the Disability Support Fund (Agyemang, 2015). 1.1 Problem Statement According to the Population and Housing Census that was carried out in Ghana in 2021 by the Ghana Statistical Service, an estimated 2,098,138 individuals, which corresponds to approximately 8 percent of the total population of 30,832,019 Ghanaians, were identified as having varying degrees of difficulty in performing activities (Ghana Statistical Service, 2022). This is a significant increase compared to the 2010 Population and Housing Census Report on Disability in Ghana which estimated 3 percent of the total population of 24 million Ghanaians as having severe disability of some kind (Ghana Statistical Service, 2014a). The results of global studies were found to be supported by the findings of the Ghana Population and Housing Census Report (2010), which found that PWDs in Ghana are more likely to be impoverished than people who do not have disabilities (Ghana Statistical Service, 2014a; Banks et al., 2017). So, PWDs suffer several deprivations of lack of access to economic and social services being found among the poorest of the poor in Ghana (Voice Ghana, 2014). This perhaps accounts for the migration of PWDs to urban centres to beg for alms on the streets of Ghana. University of Ghana http://ugspace.ug.edu.gh 7 To address poverty of PWDs and their households, the Disability Support Fund initiative appears to be a right social protection response for breaking out of poverty. This Fund seeks to support PWDs to enhance their social and economic development (Ghana Statistical Service, 2014a). Yet, efforts made to improve the welfare and protection of PWDs through this District Assembly Common Fund for Persons with Disability is not without challenges. While some district assemblies are unwilling to open separate accounts for the Fund, others do not have committees set up to manage and report on this 3 percent allocation as stipulated in the Fund’s disbursement guidelines. There are also reports of political interferences by Metropolitan, Municipal and District Chief Executives (MMDCEs) who misappropriate the Disability Support Fund (SEND Ghana, 2014). Moreover, after several years of implementation, little attention has been made to ascertain the impacts of the Disability Support Fund on PWDs household welfare within the various Metropolitan, Municipal and District Assemblies. SEND Ghana (2014) in particular avers that increased monitoring of the use of the Funds by evaluating its impact will enhance policy discourse on disability support to enhance its reach, administration and the welfare of PWDs within the various local government areas in Ghana. This serves as the primary foundation for this study, which aims to explore the accessibility to and uses of the Disability Support Fund among PWDs in the Nsawam Adoagyiri Municipality. University of Ghana http://ugspace.ug.edu.gh 8 1.2 Research Questions This research is driven by the following question: To what extent has the Disability Support Fund affected the standard of living for Persons with Disability living in Nsawam Adoagyiri Municipality? In particular, the study will address the following questions: • What is the level of awareness of the Disability Support Fund among PWDs? • How accessible is the Disability Support Fund to PWDs? • What is the effect of the Disability Support Fund on PWDs household welfare? • What are the challenges of managing the Disability Support Fund? 1.3 Research Objectives As such, this enquiry aims primarily to appraise the Disability Support Fund by studying its effect on PWDs household welfare in the Nsawam Adoagyiri Municipality. Specifically, the study seeks to: • Assess the level of awareness of the Disability Support Fund among PWDs. • Examine the level of accessibility of the Disability Support Fund to PWDs in the study area. • Analyse the effect of the Disability Support Fund on the welfare of beneficiary households. • Identify and analyse the challenges of managing the Disability Support Fund and suggest practical solutions. 1.4 Significance of the Study The study will provide information for policymakers about social protection programmes, particularly on the impact of social assistance programmes which target Persons with Disability University of Ghana http://ugspace.ug.edu.gh 9 and their households, by providing and uncovering the magnitude to which current assistance programmes have achieved their purpose. It is anticipated that the findings will also contribute to the information that the Nsawam Adoagyiri Municipal Assembly has regarding the impact that the Disability Support Fund interventions have on the beneficiaries. This can serve as a basis for reaching more private sector funders to provide additional support to expand the programme to reach more PWDs who have not benefited from the programme. It will also uncover areas which need improvement to enhance impact and sustainability of the Disability Support Fund. As an added benefit, the research will help fill gaps in the existing body of literature on social protection as a development scheme for reducing poverty in Ghana and Africa. 1.5 Limitation to Study Although PWDs were spread across the Nsawam Adoagyiri Municipality, the study focused on PWDs who had profited from the Disability Support Fund and another set who had applied but yet to benefit from the Fund in the Nsawam Adoagyiri Municipality. The sample for the study will therefore not necessarily be statistically representative of Ghana as a whole because the researcher was limited to sample from applicants and beneficiaries of the Disability Support Fund in Nsawam Adoagyiri Municipality. University of Ghana http://ugspace.ug.edu.gh 10 1.6 Definition of Concepts/Terms 1.6.1 Welfare/Well-being Though both terms are often used interchangeably, there is some little difference (Organisation for Economic Co-operation and Development, 2013). Whilst welfare is a general/broad term that includes well-being, well-being itself is often used as a term to define the standard of living of persons such as health, comfort, or happiness. In other words, welfare is a broader term that encapsulates well-being. In this study, the term welfare and well-being will be used interchangeably to mean good life, healthy, happiness, life satisfaction, etc. 1.6.2 Persons with Disability (PWDs) Those who, due to a combination of their disability and other factors, are unable to take part in society on an equivalent footing with others are said to have a disability of some kind (UNCRPD, 2006). The World Health Organisation (2021) defines PWDs as persons with long-term impairment which could be mental, intellectual, physical or sensory which in interaction with various obstacles may hamper their complete and effective engagement in society on same level with others. The definition of PWDs in Ghana is in accordance with the Persons with Disability Act 2006 (Act 715) of Ghana. According to this Act, a Person with Disability is defined as someone who has a physical, mental, intellectual, or sensory impairment that results in substantial and long-term limitation of their ability to perform normal day-to-day activities. This definition includes individuals with physical disabilities, visual impairments, hearing impairments, intellectual disabilities, developmental disabilities, mental health conditions, and other forms of impairment. The abbreviation, PWDs for Persons with Disability shall be used and maintained throughout the text to mean physically challenged, deaf and dumb, intellectually impaired, and visually impaired as explained below. University of Ghana http://ugspace.ug.edu.gh 11 1.6.2.1 Physically Challenged A person is physically challenged when he/she has physical limitations and infirmities. Such persons included but not limited to amputees, lepers, and limpers (GSS, 2014a). 1.6.2.2 Deaf and Dumb These are persons who cannot hear and have difficulty in speaking. The most common means of communication is through sign language (GSS, 2014a). 1.6.2.3 Intellectually Impaired Intellectual impairment, formerly known as mental retardation, is an impairment of mental function and adaptive behaviour that develops between birth and the start of adulthood (GSS, 2014a). 1.6.2.4 Visually Impaired A loss of vision, whether total or partial, is collectively referred to as "visual impairment" by medical professionals. These include the totally blind and partially blind such as those suffering from long and short sightedness (Ghana Health Service, 2015). 1.6.3 Assistive Devices These are devices that enable a person who needs support to carry out his routine activities that are necessary for maintaining well-being and independence to live a full life (Ministry of Health, 2020). University of Ghana http://ugspace.ug.edu.gh 12 1.7 Organisation of the Study This study is divided into five chapters. Chapter One focuses on the introduction to the study. Specifically, it provides the background to the study with the problem statement, research questions, objective of the study, significance of the study, limitation of the study, definition of concepts/terms and organisation of the study. Chapter Two entails reviews of relevant literature on the topic under study. It focuses on concepts of social protection and its international and local policy basis for the development of social protection programmes for PWDs. It also reviews other works conducted on the impact of similar social assistance programmes as a social development tool for improved welfare of PWDs. Chapter Three explains the research methodology which was employed for the study. These include research design and approach, data source, study population, sample size, sampling procedure, data collection methods, procedure for data analysis and ethical consideration. Chapter Four also focuses on the analysis, presentation and discussion of data from the field based on the research questions. Chapter Five presents the summary of findings, conclusion and recommendation of the study. University of Ghana http://ugspace.ug.edu.gh 13 CHAPTER TWO: LITERATURE REVIEW 2.0 Introduction This section presents the analysis of previous studies that have been conducted around the topic of the current study by a variety of academics. Thus, the various arguments and positions on social protection and management of Persons with Disability by scholars are brought forth and discussed. The research materials used for the review were deemed consequential to the selected themes in this chapter. The review specifically focuses on concepts of social protection and its international and local policy basis for the development of social protection programmes for PWDs. The review also captures other works conducted on the influence of similar social assistance programmes as a social development tool for improved welfare of PWDs, not excluding the concepts of disability, classification and models of disability, vulnerability, social protection, and the Disability Common Fund (DCF) also known as Disability Support Fund in Ghana. 2.1 The Concept of Disability The World Health Organisation (2021:10), defined disability as “the outcome of the interaction between individuals with a health condition (e.g. cerebral palsy, Down syndrome or depression) and personal and environmental factors (e.g. negative attitudes, inaccessible transportation and public buildings, and limited social supports)”. There are substantial differences in the experience of Persons with Disability living in different regions of the entire world (Pineda, 2020). In the globe today, there are a wide and increasing number of PWDs. It is anticipated that the findings of surveys conducted on various population subgroups, in conjunction with the observations of seasoned researchers, will confirm the figure to be 1.3 billion, which would reflect 16 percent of the total population of the world (World Health Organisation, 2022). This suggests that one in University of Ghana http://ugspace.ug.edu.gh 14 every six people is physically, mentally or sensory impaired, representing the world’s largest minority (World Health Organisation, 2022). The causes of impairments and the prevalence and impact of disability are varying worldwide (Barnes & Mercer, 2010; Heera & Maini, 2018; Palmer & Harley, 2012; Smith & Bundon, 2018; UN Enable, 2006). These variations stem from diverse socio-economic conditions and different provisions for the well-being of the members of any society (UN Enable, 2006). Research has estimated that at least 350 million PWDs live in locations in which there are no services to help them overcome their limitations (UN Enable, 2006). Generally, PWDs experience physical, cultural and social constraints that hinder their life and are more complicated with limited rehabilitative aid (UN Enable, 2006). In this regard, it is important to dive into the classification and models of the concept of disability and draw on the vulnerability and accessibility of the Disability Support Fund to the PWDs in general and particularly in Ghana. 2.1.1 Disability Classification and Models Disability as a concept has emerged in the development agenda for decades. This concept has been a contested one in terms of definition and approach (Shildrick, 2019) and remains even after the establishment of the UN Convention on the Rights of Persons with Disabilities. For this reason, several models have been developed for defining the concept. According to Palmer & Harley (2012), these can be considered in extremes as 'medical' and 'social' models, while acknowledging that there are also several hybrid models. The medical model of disability views disability as a medical problem that is inherent in an individual's physical or mental impairment (Palmer & Harley, 2012). The medical model places responsibility for addressing disability on medical professionals and health care systems. University of Ghana http://ugspace.ug.edu.gh 15 In contrast, the social model of disability views disability as a social construct that is created by societal barriers and prejudices (Smith & Bundon, 2018). The focus of the social model is on removing these barriers and creating inclusive environments that allow PWDs to fully participate in society. Hybrid models of disability combine elements of both the medical and social models, recognising the importance of medical interventions and accommodations while also acknowledging the role of societal barriers in creating disability (Palmer & Harley, 2012; Smith & Bundon, 2018). It is important to note that different models of disability have different implications for how PWDs are treated and supported. The medical model can lead to a focus on cure or fix, while the social model emphasises the importance of creating inclusive environments and removing barriers to participation. The International Classification of Functioning (ICF) model for disability and health is the only one that is included in the discussion of hybrid models. Within that context, the United Nations Convention on the Rights of Persons with Disabilities is used to assess the current definition of PWDs. According to the United Nations Convention on the Rights of Persons with Disabilities (UNCRPD), Persons with Disabilities (PWDs) are people who have had a physical, mental, intellectual, or sensory impairment for a long period of time and who face a variety of barriers that may prevent them from fully and effectively participating in society (Kazou, 2017). Throughout history, the tendency has been to explain the experience of impairment that PWDs have, which is known as the medical model in ontology. Disability is seen as created by physical impairments arising from illness, accident or circumstances of health (Barnes & Mercer, 2010). The general idea of this model is that the loss University of Ghana http://ugspace.ug.edu.gh 16 of physical and social function results directly from deficiency. Therefore, interventions primarily consist of medical care and care provided by institutions, such as programmes for career education, special education, and safety net programmes, which also include social support programmes (Palmer & Harley, 2012). 2.1.2. Disability and Vulnerability The term "vulnerability" has become somewhat of a catchphrase in contemporary discussions of human rights. There may be a trend toward the particularisation of the human right, with the special protection of individuals, especially the typically overlooked, as evidenced by the broadening of the rationale of vulnerability (Heikkilä et al., 2020). Affirmative actions and/or special protections for PWDs are examples of this (Clough, 2017; Heikkilä et al., 2020; Negrón, n.d.). The significance of the contested exclusion of vulnerability as a notion from the standard discourse on disability, however, cannot be overstated. This is likely due to the fact that people have negative preconceptions about the concept and view disability as an ontological factor that helps maintain the status quo in social power structures (Clough, 2017). The principle of universal application is central to the framework of international human rights law, which states that human rights are applicable to everyone (Nifosi-Sutton, 2017). A priori, this sort of universalism rested heavily on the liberal subject's belief that each person has the agency to assert his or her rights (Kapur, 2014). However, since some time ago, a notable change in the reflection in the human rights law has taken place and this is because, people are increasingly aware that while rights are universal and equal for all, certain groups and individuals confront specific problems in achieving their human rights making them vulnerable to some extent (Bossuyt, 2015). Persons with Disability are one of these University of Ghana http://ugspace.ug.edu.gh 17 groups that are routinely denied their human rights, both legally and in practise (Mégret, 2017). Meanwhile, a number of theorists challenge the traditional vulnerability approach, seeing it as an interconnected, relational or universally ontological idea, connected to an inherent condition such as age or impairment, that is framed to fit all groups or statuses (Clough, 2017). Vulnerability and disability are intertwined and, as a result, they produce specific contradictions (Lid, 2015). The link between vulnerability and disability can be seen from one perspective: PWDs are more vulnerable to discrimination compared to the majority of the people (Dammeyer & Chapman, 2018). Another perspective is the recognition of the vulnerability of all individuals (Mattila & Papageorgiou, 2017). At the fundamental level, the vulnerability of the person might be regarded as inherent to the human situation (Lid, 2015). Each person has a unique perspective on what it means to be vulnerable. A person's risk of developing a disease can be raised by variables such as their age, sex, race, and health status, and even by differences in their physical appearance and their genes (Ahlvik-Harju, 2014). Biotechnology allows for the development of tools that can reveal characteristics of the developing foetus (Lid, 2015). Thus, biotechnology heightens the precarity already present due to impairment or the fear of future disability. An individual who carries a genetic differences or has a distinct appearance may be informed that a foetus with the same attributes can be identified while still developing in the womb (Lid, 2015). New policies have been developed in response to unfortunate historical incidents involving exclusion, with the goal of ensuring that PWDs are able to fully participate in all aspects of society. The political and legal basis for inclusion is provided by various national laws and international agreements pertaining to human rights. This is of paramount importance and exemplifies why the United Nations Convention on the Rights of University of Ghana http://ugspace.ug.edu.gh 18 Persons with Disabilities (UNCRPD) was created. Understanding the impairment as stemming from the interrelationship between a person and his or her environment, as found in the UNCRPD, is very crucial in the analysis of weakness as a human state (Lid, 2015). An individual becomes vulnerable due to legislation, politics, or even human factors like impairments (Lid, 2015). With both as life experience and as abstract notions, vulnerability and disability are associated with personal worth (Lid, 2015). People's wishes to avoid disability, for example, are usually not controversial (Shakespeare, 2013). Therefore, for these individuals, the value of a life free from impairments and disability experiences is higher than the value of a life marked by these factors (Sayer, 2011; Shakespeare, 2013; Vehmas & Watson, 2014). In terms of the relationship between vulnerability and disability, scholars have described it as a complex one (Fukuroku et al., 2021; Gould, 2021; Laes, 2020; Wilton et al., 2020). PWDs are subject to hate crime and are excluded from attitudes and social welfare reforms (Lid, 2015). In many aspects of society, people who live with impairments are much more vulnerable to exclusion, as highlighted in the 2011 World Disability Report (Bickenbach, 2011) compared to those without disabilities. In Ghana, for example, this is more prevalent and even worse in rural settings (Abrokwah et al., 2020; Baffoe, 2013; Naami et al., 2012; Opoku et al., 2019). As a result of the widening gap in exclusion and access to social services, governments are making attempts to include PWDs in their policy frameworks (Chihiyo, 2016). According to the research that has been done, disability and vulnerability are inextricably linked, and this must be treated as a serious issue if alleviating poverty and preventing discriminatory practices is the responsibility of both local and national governments. University of Ghana http://ugspace.ug.edu.gh 19 2.2 Concept of Social Protection Over the past three decades, policymakers in both developed and developing countries have shown a growing interest in the provision of welfare assistance as a means of combating poverty, vulnerability, and social exclusion. The efforts that governments in developing nations are making to alleviate poverty on a national scale are increasingly including the implementation of social safety programmes. The term "social protection" can refer to a wide range of different things depending on the context. On the other hand, in developing countries, social protection schemes have focused primarily on social assistance, which includes various policies and programmes aimed at reducing poverty (Barrientos, 2010). This is in accordance with the definition of social protection provided by Walsham et al. (2019), who argued that it encompasses programmes such as government aid, national insurance, interventions in the labour market, and social care that aim to mitigate the effects of financial risk, alleviate poverty, and improve people's standard of living. This is in line with the definition of social protection provided by Walsham et al. (2019). The 1990s were a time of significant change for safety nets, particularly in countries that were still in the process of developing. As a part of the social policy platform in developing nations due to financial crises, structural reforms, and global economic integration, the importance of social protection has increased over the past few years. Most world leaders have re-evaluated the importance of including social protection policies in their ongoing transformation agendas in order to provide stability for the most vulnerable and economically disadvantaged citizens of their countries. Therefore, it is critical to trace the geneses of various social safety strategies back to the varying worldviews from which they emerge. As a result, some argue that social protection should be grounded in a rights-based framework for human development, while others insist that it should University of Ghana http://ugspace.ug.edu.gh 20 be understood in terms of guaranteeing that people's fundamental necessities are met (Cechina & Rico, 2012). Due to the significance of social policy, the idea of social protection has been defined and understood in different ideological frameworks. Social protection, as described by Devereux et al. (2012), evolved out of the social safety nets agenda that formed a major part of development strategy in the 1980s and 1990s and drew inspiration from European social security systems established in the late 19th century. The UN provides a useful definition of social protection (United Nations, 2000). Social protection was defined by the United Nations as "a set of governmental and non - governmental initiatives undertaken by societies in light of current contingencies to mitigate the utter lack or massive reduction in work income; and provide more assistance to households with children; and to provide individuals with basic health care and accommodation" (United Nations, 2000:4). In this sense, social protection encompasses any and all programmes that offer some form of monetary or non-monetary benefit to help people feel safe and secure in their financial situations and have access to necessary medical care. Despite this, other definitions exist that expand beyond the aforementioned examples. Access to education, social work, and collective care, as well as other initiatives like labour market policies, have been included, for example, by the World Bank (2012) and UNDP (2013). This perspective broadens the duty of social safety to include satisfying basic human needs, which is necessary for both individual and societal development and economic progress. The United Nations Children's Fund, also known as UNICEF, has developed a plan to assist the economically disadvantaged and those who are poor. The four pillars of social protection identified by this strategy are programmes for social transfers to provide accessibility to services, support networks and welfare services, legal and policy reforms (UNICEF, 2008). University of Ghana http://ugspace.ug.edu.gh 21 Social protection is defined by the International Labour Organisation (ILO) as a collection of state bodies, regulations, and strategies that help to protect individuals and families from occurrences that jeopardise their capacity to meet their most fundamental needs. Social insurance, social assistance, and regulation of the labour market are the three pillars upon which they build their system of social protection. Social insurance encompasses a broad range of safety net programmes that help people weather the financial storms resulting from unexpected life events like pregnancy, ageing, or job loss. People who are particularly vulnerable and poor can receive social support through social assistance programmes, which are typically funded through taxation. Finally, labour and employment laws establish minimum standards for the workplace and strengthen the position of workers' organisations and collective bargaining (Barrientos, 2010). However, the ILO's theories show that this type of social security does not effectively help the most vulnerable members of society or the poor. These safety nets focus exclusively on the workplace. Social protection can be broken down into four categories, according to Sabates-Wheeler and Devereux (2008): provision, prevention, promotion, and transformation. One way to think about social protection is as a mechanism for incorporating the requirements of members of society who are economically disadvantaged, excluded from society, defenceless, or marginalised into the functioning of the various aspects of society. The job market, the economic system, daily life, way of life, civic participation, schooling, medical services, and income brackets are some of the areas that are going to be targeted by social protection efforts (Devereux et al., 2013). University of Ghana http://ugspace.ug.edu.gh 22 2.2.1 Social Assistance Social assistance is known variously in the literature as provision measures. Social assistance is defined by O'Brien et al. (2018) as non-contributory interventions designed to assist individuals and families in coping with economic hardship, abject poverty, and frailty. These programmes are intended for the poor and deprived. Some are targeted at low-income households, while others are focused on categories of vulnerability. They are generally funded by national taxes and given by the government (Barrientos, 2010). Clearly, according to Cuesta et al. (2021), social assistance refers to the advantages that the government of a country provides to vulnerable populations such as PWDs, orphans, children from low-income families, and the elderly. Social assistance includes cash transfers, in-kind transfers, vouchers, public work programmes (cash and food for work), fee waivers for health and education, and social support services (O'Brien et al. 2018). Donors and international agencies have emphasised social assistance, especially cash transfer programmes. In order to test the efficacy of these programmes, they are given seed money to run a pilot. United Nations Children's Fund (UNICEF), the United Kingdom's Department for International Development (DFID), German Technical Cooperation (GTZ), the Danish International Development Agency (DANIDA), and the World Bank are just some of the major institutions that support most cash transfer programmes in Africa (United Nations Development Programme, 2013; Adjei-Domfeh, 2015). 2.2.2 Social Insurance Social insurance programmes are designed to protect people from financial ruin in the event of disasters or the loss of employment (Zastrow & Hessenauer, 2022). The government or the University of Ghana http://ugspace.ug.edu.gh 23 employees themselves may contribute to the cost of this type of insurance. The elimination of poverty is central to this plan, which is why it emphasises universal health care and other types of social security. All governments should provide their citizens with these amenities because they are a fundamental human right. Health care, unemployment, parental leave, disability, and retirement benefits are just some of the services provided. 2.2.3 Transformative Social Protection Transformative social protection aims to end inequalities in society, like prejudice against minorities and exploitation of workers (Devereux & McGregor, 2014). Transformative measures include campaigns to raise awareness (like the HIV/AIDS Anti-Stigma Campaign) and joint action to safeguard workers' rights, as well as regulatory changes to protect "socially vulnerable groups like PWDs or domestic violence victims" from abuse (Devereux & McGregor, 2014). 2.3 International Instruments on Social Protection Over the past few decades, international instruments have been implemented to guarantee state support for disadvantaged people, security, and people's rights. A literature review cites the Universal Declaration of Human Rights, the International Labour Organisation's Conventions on Social Security, the Convention on the Rights of the Child, and the Convention on the Rights of Persons with Disabilities as prominent international instruments supporting social protection. 2.3.1 Universal Declaration of Human Rights As the first international document to ensure safety and security for all persons, the Universal Declaration of Human Rights was a ground-breaking achievement. The United Nations General University of Ghana http://ugspace.ug.edu.gh 24 Assembly (UNGA) approved this document on 12/10/1948. After World War II, the international community demonstrated its resolve to prevent future atrocities by forming the United Nations (UN). The Universal Declaration of Human Rights (UDHR) is widely recognised as the cornerstone of international human rights law, a driving force in the fight against injustice, and a practical resource for guaranteeing that all individuals, everywhere are able to fully realise their human rights. The belief that all humans are born free and equal in dignity and rights and have the right to freedom, dignity, and the pursuit of happiness is consistent with the above (Mitchem, 2013). The preamble explains the declaration's premises, and subsequent articles emphasise community protection and security. Article 22: Every person has the right to a minimum standard of living and to the realisation of the economic, social, and cultural rights necessary for his dignity and the free development of his personality, within the framework of national efforts and international cooperation, and in accordance with the organisation and resources of each State. Article 25: a. Everyone has the right to a standard of living that ensures both their own and their family's physical and mental health and well-being, including access to sufficient food, clothing, housing, medical care, and other essential social services; and the right to financial stability in the event of unexpected loss of income due to unemployment, illness, disability, death, or other unavoidable life events. b. There should be extra support for mothers and children. Children born within or outside of marriage should be afforded the same legal and financial protections. University of Ghana http://ugspace.ug.edu.gh 25 2.3.2 International Labour Organisation’s Conventions on Social Security The International Labour Organisation (ILO) is the UN department mandated with enforcing the right to societal security. The ILO has made a significant commitment to promoting social security systems among all countries, which was recognised in Article III (f) of the International Labour Conference's 26th session, 1944. The 1944 Philadelphia Declaration argues that everyone in need of financial stability and medical coverage should be entitled to at least a minimum wage (Annapoorani, 2017). According to Kuhlman and Blum (2019), the ILO's pre-war social security conventions were replaced by newer, more comprehensive ones in the "societal security era" that followed World War II. Regardless, the International Labour Organisation's (ILO) social security agreements served as the primary resource for understanding the nature and components of this right. Adopted in 1952, the ILO’s Social Security (Minimum Standards) Convention is now widely known as ILO Convention No. 102. There are nine different aspects of social security that are discussed at the 102nd Convention: Medical care, sickness benefit, unemployment insurance, retirement benefits, worker's compensation, family benefit, maternity pay, disability benefits, and death benefits. 2.3.3 Convention on the Rights of Persons with Disabilities Convention on the Rights of Persons with Disabilities guarantees civil, political, financial, socioeconomic, and cultural rights for PWDs through its fifty articles. A satisfactory living standard and social protection are guaranteed in Article 28. (United Nations General Assembly 2006). This article emphasises that; University of Ghana http://ugspace.ug.edu.gh 26 1. State Parties shall take appropriate measures to protect and promote the realisation of the right of PWDs to a decent standard of living for themselves and their families, including access to adequate food, clothing, and housing, free from discrimination on the basis of disability. 2. The right of PWDs to social protection must be safeguarded and advanced by all means necessary, and each Party State must do so in a variety of ways. a. See to it that PWDs have equal access to safe drinking water, as well as appropriate and reasonably priced services, equipment, and other forms of disability-related support. b. For PWDs to have equal access to social security and poverty-reduction programmes, with special attention paid to women and girls and older PWDs. c. Make sure low-income PWDs and their families can get the preparation, mentoring, financial aid, and supportive services they need without having to worry about where the money will come from. d. Ensure that PWDs have access to public housing programmes e. To guarantee that PWDs have rightful access to retirement benefits and programmes. Numerous global documents, such as the Universal Declaration of Human Rights, the International Labour Organisation, and the Convention on the Rights of Persons with Disabilities, guarantee the right to social security and protection, which will be discussed in more detail below. By becoming parties to these international instruments, governments commit to upholding, protecting, and fulfilling human rights under international law. University of Ghana http://ugspace.ug.edu.gh 27 2.4 Social Protection and Vulnerability Reduction The social protection theories developed in the 1980s are likely the forebears of the term social protection (Reisch & Andrew, 2014). As a concept, social protection provides a framework for further discussions on the poverty reduction strategy involving risk management and establishing policies on social welfare programmes in developing nations (Carter et al., 2018). Increasingly the social protection domain has been extended to include the establishment of an environment that enables persons to secure their livelihood, including social security (or social welfare) (Fernando & Moonesinghe, 2012). Social protection implies that public efforts made to address the degree of vulnerability, risk and deprivation that under a specific policy or society is regarded as socially undesirable (Palmer, 2013). Social protection has been a major policy instrument in developing nations during the last decade to address poverty, vulnerability and social exclusion issues (Devandas A., 2017; Palmer, 2013). Developing countries' governments have progressively taken initiatives to include social support programmes in their national poverty reduction agendas. Meanwhile, in different contexts, the term social security has wide connotations and implications. However, in developing countries, social protection plans are centred on policies and programmes that aid the poor (Barrientos, 2010; Devandas A., 2017). In this case, according to Palmer (2013), support plays a wide-ranging developmental role in the social protection paradigm by ensuring not only the stability of income but also the protection of rudimentary consumption intensities, encouraging investing in human and other industrious assets, and fortifying agencies and social capital. University of Ghana http://ugspace.ug.edu.gh 28 Persons with Disability are poor and stigmatised, and policymakers and development experts are increasingly aware that PWDs must be included in strategic plans for poverty reduction (Mulumba, 2011). Typically, domestic social protection programmes include cash transfer programmes, non- contributory health care insurance schemes, society rehabilitation, educational and vocational training programmes, and increasingly, programmes for PWDs. Although some social security programmes are designed specifically for PWDs, others include disability-related measures for people on the margins who are considered "mainstream" (Palmer, 2013). However, because of the great costs and limited administrative ability for targeted disability programmes, mainstream programmes are more common in less developed countries. However, there is some wiggle room when it comes to the severity of impairment within low-income countries' standard programming (Allen, 2017). 2.5 Access and Impact of Social Assistance Interventions in Africa Many African nations provide comprehensive social protection programmes with numerous safety nets for their citizens. Housing and food security, schooling and well-being, social integration, and political strength are all goals of social protection programmes (Omolola & Kaniki, 2014). To be clear, the majority of African governments work with larger international non-profit organisations and development partners to implement social protection programmes. The mainstay of these countries' social protection interventions is specific welfare programmes like provisional and indisputable cash transfers, school - based feeding initiatives, market intervention price control, and policy changes. University of Ghana http://ugspace.ug.edu.gh 29 Consistent with the above, the impacts of social interventions (often known as social protections) are globally well recognised as enhancing the livelihood of the poor, especially in Africa. This triggered researchers’ curiosity to take a new look into the area. In the previous two decades, social protection programmes and research have been rapidly increasing, as researchers continue to assess their accessibility and influence on the welfare of the African population (Hidrobo et al., 2018). The accessibility of social intervention programmes in several developing economies is restricted to a limited proportion of people in the formal sector; who are relatively well-positioned economically (Hidrobo et al., 2018). Henceforth, social support which is generally aimed at helping the poor, end up not meeting its objectives. In low-income nations, where it has been demonstrated that the most disadvantaged segments of the population are disadvantaged where 80% of PWDs live (Saran et al., 2020). Government social intervention programmes have developed across several poverty-prevalent areas of sub-Saharan Africa to provide a variety of services such as food, clean water, care and support to support the poor, especially PWDs. Meanwhile, in many low-income nations, PWDs are continuously deprived of access to critical services, which contribute to their high poverty rate (Opoku et al., 2019). For this and other reasons, there is a rise in advocacy campaigns for the inclusion of PWDs in the developing agenda of African governments; to ensure social intervention programmes are made accessible to PWDs. Despite the prevalence of social intervention programmes aimed at this group, Walsham et al. (2019) claim that there is insufficient proof that PWDs are included in social welfare programmes and initiatives in middle and lower countries. University of Ghana http://ugspace.ug.edu.gh 30 According to studies carried out in nations like Peru and Tanzania, state welfare rates (in terms of wealth, medical needs, and other various socio - economic initiatives like education and reliance ratios) for PWDs are not greater than they are for the general public (Bernabe-Ortiz et al., 2016; Kuper et al., 2014). These studies also indicated that additional barriers, such as costs to PWDs, were not taken into consideration when designing individual social intervention programmes using state legal and policy instruments, despite commitments to disability inclusion. Therefore, further action has to be taken to ameliorate their situation and give PWDs access to social services. 2.6. State of Disability and Social Protection in Ghana In recent years, government and non-government entities have directed attention to PWD-centred problems. Successive Ghanaian administrative governments have tried to enhance the PWD's well- being. Parliament in Ghana passed the Disability Act in 2006. This was a significant step toward fulfilling the national commitment (Arkorful et al., 2020). Human resource development and community-based rehabilitation initiatives have also been launched by the government to aid PWDs. The Government of Ghana allocated 3% of the District Assemblies Common Fund (DACF) in the form of a Disability Support Fund in order to ensure the welfare and dignity of PWDs, to promote income-generating activities, to encourage the education of PWDs and their children, schoolchildren, and trainees with physical handicaps, to construct district capabilities for PWDs to safeguard and assert their interests, and to improve their understanding (National Council On Persons With Disability, 2010). Thus, it is evident that a successful implementation of the social protection programme, along with increasing its involvement in the economy, might help reduce the burden on PWDs (Devandas, University of Ghana http://ugspace.ug.edu.gh 31 2017) and at the same time facilitate their engagement in economic activities (Levine et al., 2011; Palmer, 2013; Devandas, 2017). Communities in Ghana have social protection due to the country's strong sense of community, but this model cannot continue indefinitely because of the negative effects of urbanisation, migration (Abebrese, 2011) and a condescending attitude towards PWDs (Anthony, 2011; Baffoe, 2013). Despite pledges from many governments to improve the lives of Persons with Disability (National Council on Persons with Disability, 2010), many PWDs still rely heavily on the kindness of strangers just to get by. As a result, the study emphasises strongly the part that the government plays in enforcing social safety net programmes. 2.7 The Disability Support/Common Fund In the early years of this century, the fight against economic and social poverty in the world's poorest nations became a top priority for the international community (Hajian & Kashani, 2021). Under the Millennium Development Goals (MDGs), the United Nations has directed the charge to increase the availability of social services and to end severe destitution in a number of countries (United Nations, n.d.). In spite of the fact that some countries, like Ghana, have made substantial progress toward achieving the MDGs, many of the goals set to achieve by 2015 could not be achieved in countries designated for the programme, and the scope of this programme was criticised as inadequate (Fukuda-Parr, 2016; Ruhil, 2015; Sachs, 2012). However, the needs of PWDs were largely ignored in the MDGs, which seemed to have guided the development of a more general programme to absorb the most vulnerable populations (Thomas, 2019). The United Nations has thus developed the Sustainable Development Goals (SDGs), a transforming agenda of the MDGs designed to reduce all types of poverty by 2030 (Independent Commission for Aid Impact (ICAI), 2017; Sachs, 2012). In this programme, countries are mandated (as outlined in the University of Ghana http://ugspace.ug.edu.gh 32 SDGs) to improve the welfare of their citizens by developing adequate social systems. In light of this situation, the government of Ghana founded the Ghana Disability Support Fund to aid Persons with Disability. Over the past few years, the government of Ghana has taken several significant policy and actionable steps to reduce the poverty rate and expand the economic and social inclusion of PWDs in the country (Edusei et al., 2017). Welfare support in the form of money transfers has become extremely relevant, especially for PWDs, as part of the nation's initiatives to reduce poverty (Adjei et al., 2020). According to Edusei et al. (2017) the Livelihood Empowerment Against Poverty (LEAP) programme, which is aimed at poverty reduction but also serves as a general safety net, includes a large group of PWDs. Also, as part of the National Disability Scheme, PWDs have access to the Disability Common Fund (DCF), also known as the Disability Support Fund. The government of Ghana launched a programme called the Disability Common Fund (DCF) to help the country's PWDs out of poverty (Edusei et al., 2017). To assist PWDs with their financial needs, the DCF was established in 2005 through the District Assemblies Common Fund (DACF). Three percent of the DACF allotted to each MMDA is designated for Persons with Disability. Despite the benefits on PWDs’ daily lives, the research team Edusei et al. (2017) found that these Funds were insufficient. There were also setbacks in the distribution process for PWDs (Edusei et al., 2017). 2.7.1. Accessibility of the Disability Support Fund to PWDs in Ghana Globally, Persons with Disability have struggled for decades to gain access to public resources and services (Edusei et al., 2017; Badu et al., 2018; Senayah et al., 2019). PWDs are more likely to University of Ghana http://ugspace.ug.edu.gh 33 experience difficulty gaining access to social and economic resources and opportunities than their not-so-challenged peers (Sackey, 2015). Most recipients of the Disability Support Fund in Ghana have reported lengthy wait times and other difficulties when attempting to access the funds through the MMDAs. SEND Ghana (2010), for instance, found that DCF recipients often had to wait a long time for their share of the Fund, with many recipients only receiving it once a year rather than four times. According to Edusei et al. (2017), recipients of the Disability Support Fund received amounts too small to make a meaningful difference in their lives, and the cash was often disbursed late, making it impossible for PWDs to save or invest for the long-term. In an effort to examine the reach and accessibility of the Disability Support Fund, Opoku et al. (2019) found issues with insufficient funds available to beneficiaries, a lack of information about the Disability Support Fund, and delays in disbursement. According to further explanation provided by Opoku et al. (2019), nearly all study participants were unaware of the application process, the grant amount, or the time intervals between disbursements from state governments to the MMDAs. Studies have shown that management of the Social Welfare Offices at the MMDAs in Ghana tend not to open up to PWDs. This is because some of the officers often do not reveal all information regarding the Fund to the beneficiaries (Opoku et al., 2019). Meanwhile, the ability of PWDs to invest in profitable income-generating businesses requires a consistent flow of social assistance to such beneficiaries (Banks et al., 2017). Additionally, the study of Banks et al. (2017) revealed that disability types did not only post limitations on the accessibility to public facilities, but also limited the accessibility to the Disability Support Fund. PWDs have been refused access to a variety of services in the past, ranging from childcare and mental health counselling to assistance in retail/support provision establishments and entertainment, due to a lack of physical University of Ghana http://ugspace.ug.edu.gh 34 accessibility or discomfort, unfamiliarity, or preconceptions about their disability types (Community Tool Box, nd.). This could also affect the general welfare of PWDs of a country. 2.7.2 Effects of Disability Support Fund on PWDs From the review of available literature, it was quite clear that the Disability Support Fund (Disability Common Fund in Ghana) has proven to be a significant initiative that contributes to poverty alleviation among PWDs. For its beneficiaries, the Disability Support Fund has many advantages. Listed below are just a few of the many ways in which this Fund improves the quality of life for Persons with Disability. • The Fund supports the education of PWDs on their rights, capabilities and responsibilities; • It has the potential for full national development participation and ensures that PWDs have access to education and training at multiple levels. • It enhances PWDs’ employment opportunities in various sectors of the economy. • It facilitates PWDs’ accessibility to good health care, and medical rehabilitation services. • It guarantees that PWDs who are women have the same opportunities as their men counterpart. • The Fund fosters the full involvement of PWDs in cultural events. • Promotes friendly road transportation and housing to PWDs. • Ensures that PWDs have the same leisure (such as tourism) and sports options as other citizens without disability (National Disability Authority, 2014) University of Ghana http://ugspace.ug.edu.gh https://ctb.ku.edu/en/table-of-contents/implement/physical-social-environment/housing-accessibility-disabilities/main 35 In sum, the beneficial effects of the Fund in supporting PWDs are myriad and give them an inclusive and equal opportunity similar to that enjoyed by other members of the society. In assessing the benefits of the Disability Support Fund in his study in Ghana, Arkorful et al. (2020) found that, while the beneficiaries (PWDs) were unsuccessful most of the time, they attempted to use their benefits for business enterprises. They also took the responsibility for additional personal expenses to improve their living conditions. Meanwhile, they wanted to get more rewards from the Disability Support Fund to invest in profitable businesses than they receive (Arkorful et al., 2020). 2.7.3 Challenges in managing Disability Support Fund Access to even the most basic forms of social protection is still a nightmare for the vast majority of people in many low-income countries (LICs). In many countries, especially those whose projects rely on funding from bilateral donors and non-governmental organisations, the effects of the financial and economic crisis of the last few decades have threatened the viability of such interventions (Chitonge, 2012). While lack of financial resources remained a key concern for many nations in Sub Sahara Africa, it is not the sole nor the most serious challenge in managing disability support services. There are equally latent challenges in managing disability support welfare. The fundamental hurdles to increasing social protection in Ghana and elsewhere in Africa include a lack of political commitment, weaker institutional capacity, inappropriate social welfare models, lack of financial resources and over emulation of the social welfare models of developed countries (Chitonge, 2012). Particularly, research in Sub Saharan Africa has revealed that the adoption of social protection models from wealthy countries’ is increasingly failing to alleviate poverty and University of Ghana http://ugspace.ug.edu.gh 36 vulnerability in Africa. These and many others serve as barriers to the enrolment of disability grants in Africa (Chitonge, 2012). Additionally, in most developing countries such as Ghana, research has revealed that a key impediment to the effective implementation and operation of cash transfer programmes is the lack of institutional capacity in the public sector (Speer, 2012). The number of administrators for disability grants is equally inadequate. The available few personnel (administrators) may lack the prerequisite skills and expertise to deal with PWDs, especially if they have communication issues (Houtenville & Kalargyrou, 2012). It is therefore critical for institutions that are in charge of managing disability support welfare interventions to build capacity to ensure positive frameworks towards addressing vulnerability and poverty in developing countries. Countries that have national social protection programmes like the Disability Support Fund in place are managed by the national machinery of those countries. Ghana in particular has a National Council on Persons with Disability under the Department of Social Welfare in collaboration with metropolitan, municipal and district assemblies’ representatives across the country (NCPD, 2010). However, it can be said that not much can be said about them in relation to the successes that they have chalked over the years. The lack of national data on all PWDs in Ghana could be a factor that accounts for such failures. It is also important to pay critical attention to this and other managerial challenges. 2.8 Theoretical Framework The researcher of this study implemented a theory of monetary transfers developed by Bastagli (2009). Based on this theory, we can see how direct cash transfers and other forms of targeted social protection can help the economy grow while also giving recipients the tools they need to University of Ghana http://ugspace.ug.edu.gh 37 become self-sufficient. This concept provides the best justification for the importance of the Disability Support Fund despite the state's financial constraints. The available literature on social cash transfers suggests that they can help the poor develop in a number of different ways, such as by serving as a risk management tool, facilitating the growth of human capital, and freeing low- income families from what seems to be a perpetual cycle of poverty. The theory of monetary transfers, as developed by Bastagli (2009), is based on the idea that providing financial resources directly to individuals and households can be an effective means of reducing poverty and promoting social inclusion. This theory can be applied in the management of funds for PWDs in a number of ways. Firstly, the theory suggests that providing financial resources directly to PWDs can help them to overcome the barriers they face in accessing education, employment, and other opportunities. This could involve providing direct cash transfers to individuals with disabilities to help cover the costs of assistive technologies, transportation, or other expenses that can be barriers to participation in education or employment. Secondly, the theory suggests that providing financial resources directly to households with members who have disabilities can help to address the additional costs and burdens that families with disabilities often face. For example, a household with a member who has a disability may face higher healthcare costs or may need to modify their home to accommodate the needs of the person with the disability. Direct cash transfers to households could help to cover these additional expenses and improve the overall well-being of the family. University of Ghana http://ugspace.ug.edu.gh 38 Overall, the theory of monetary transfers can be applied in the management of funds for PWDs by prioritising direct financial support for individuals and households, rather than relying solely on institutional support or indirect forms of assistance. By providing financial resources directly to those who need them most, this approach can help to reduce poverty, promote social inclusion, and improve the quality of life for PWDs and their families. The theory of monetary transfers has been applied in a number of studies investigating the effectiveness of different social protection programmes and poverty reduction strategies. Here are a few examples of studies that have used this theory: 1. "Cash Transfers and Child Schooling: Evidence from a Randomised Evaluation of the Role of Conditionality" by Baird, McIntosh, and Ozler (2011) - This study examines the impact of conditional and unconditional cash transfers on children's school enrolment and attendance in Malawi. The results suggest that unconditional cash transfers are more effective at improving school attendance, while conditional transfers are more effective at improving enrolment. 2. "The Impact of a Social Cash Transfer Programme on Nutritional Status of Children in Cambodia" by Fenn and Noura (2012) - This study evaluates the impact of a social cash transfer programme on child nutrition in Cambodia. The results suggest that the programme had a positive impact on the nutritional status of children in poor households. University of Ghana http://ugspace.ug.edu.gh 39 An example in Ghana is the Livelihood Empowerment Against Poverty (LEAP) programme which has had some impact on PWDs. The LEAP programme is a social intervention programme that provides cash transfers to the poorest households in Ghana to reduce poverty and vulnerability (Ministry of Gender, Children and Social Protection, 2016). The programme targets vulnerable groups such as PWDs, orphans and vulnerable children, and the elderly. According to a 2017 report by the Ghana Statistical Service, 21.5 percent of LEAP beneficiaries are PWDs (Ghana Statistical Service, 2017). The programme has provided cash transfers to PWDs to help them meet their basic needs such as food, healthcare, and education. It has also helped PWDs to undertake vocational training and also start small businesses. This has helped to improve their livelihoods and increase their economic independence. However, there are still some challenges facing PWDs in accessing the LEAP programme. Some PWDs may not be aware of the programme or may face barriers in accessing the programme due to physical and social barriers. Although more needs to be done to address the challenges facing the accessibility of the programme, the Government of Ghana has taken steps to address these challenges by increasing the awareness of the programme and providing support to PWDs to help them access the programme. The OECD (2017) states that these transfers may be universal or directed at a specific population. Ghana is just one of a handful of developing nations that has taken the initiative to guarantee the right to social protection for Persons with Disability in its constitution. In an effort to reduce poverty, the government of Ghana has established the Disability Support Fund, modelling it after similar programmes in other countries. Countries like Mexico, Brazil, and South Africa have implemented comprehensive social rights systems, leading to dramatic improvements in their respective poverty and inequality indicators over the past decade (Birdsall et al., 2012). University of Ghana http://ugspace.ug.edu.gh 40 A 2017 OECD review found that cash transfers are effective risk management techniques for the poor and vulnerable because they do three things: reduce poverty, reduce vulnerability, and strengthen coping mechanisms in the face of shocks like economic and natural disasters. Distribution of funds that is fair to all members of a community and the nation as a whole has a positive impact on social harmony and patriotism while reducing friction between citizens (Durrani & Halai, 2018). Individual motivation requires a safe, secure, and stable environment. Studies have shown that social cash transfers improve people's lives by expanding their opportunities to receive healthcare, education, and income. Several studies have found substantial positive responses to conditional and unconditional health and education initiatives in South Africa and Latin America, including those