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The capability approach pioneered by Amartya Sen and Martha Nussbaum offers a new paradigm to examine disability, poverty and their complex associations. Disability is hence defined as a situation in which a person with an impairment faces various forms of restrictions in functionings and capabilities. Additionally, poverty is not the mere absence of income but a lack of ability to achieve essential functionings; disability is consequently the poverty of capabilities of persons with impairment. It is the lack of opportunities in a given context and agency that leads to persons with disabilities being poorer than other social groups. Consequently, poverty of people with disabilities comprises of complex processes of social exclusion and disempowerment. Despite growing evidence that persons with disabilities face higher levels of poverty, the literature from low and middle-income countries that analyzes the causal link between disability and poverty, remains limited. Drawing on data from a large case control field survey carried out between December 24th , 2013 and February 16th , 2014 in Tunisia and between November 4th , 2013 and June 12th , 2014 in Morocco, we examined the effect of impairment on various basic capabilities, health related quality of life and multidimensional poverty – indicators of poor wellbeing-in Morocco and Tunisia. To demonstrate a causal link between impairment and deprivation of capabilities, we used instrumental variable regression analyses. In both countries, we found lower access to jobs for persons with impairment. Health related quality of life was also lower for this group who also faced a higher risk of multidimensional poverty. There was no significant direct effect of impairment on access to school and acquiring literacy in both countries, and on access to health care and expenses in Tunisia, while having an impairment reduced access to healthcare facilities in Morocco and out of pocket expenditures. These results suggest that public policies in Morocco and Tunisia must create additional and targeted opportunities for persons with disabilities through innovative social arrangements to improve wellbeing. [ABSTRACT FROM AUTHOR]

The Sustainable Development Goal four aims at ensuring inclusive, free and equitable quality education. In a conflict setting such as Western Darfur, the education system has been destroyed, leaving millions of children out of schools. Various stakeholders, namely UNICEF and non-governmental organizations, have taken initiatives to rebuild schools and include all children since the beginning of the conflict in 2003. However, very little evidence is available to date on the education of children with disabilities living in conflict and post-conflict situations. Between the 1st of October 2008 and the 28th of February 2009, we carried out a household survey in all localities and settlements in the rural council of Um Kher, part of the locality of Wadi Salih in the state of West Darfur, Sudan. We interviewed 11,089 heads of household about activity limitations and functioning difficulties associated with a health problem among all family members using a validated screening instruments, as well as 1436 children on various aspects of access to education, learning outcomes and psychological wellbeing. We found that in a context of protracted conflict, all children are at high risk of being excluded from schools and not learning when in school. We also found that children with disabilities were at higher risk of poorer psychological wellbeing, particularly those children with behavioral and mood disorders, as well as associated disabilities. In a context of conflict and protracted crisis such as Darfur, promoting education requires a lot of external effort to ensure access and positive learning outcomes for all children, including children with disabilities. Our study shows poor basic cognitive learning outcomes for all children and the limited effectiveness of the protection of children in schools. Improving learning outcomes and mental wellbeing of vulnerable children in conflict, crisis and protracted crisis contexts require multilevel and multipronged interventions within and outside schools. [ABSTRACT FROM AUTHOR]

Abstract: This paper presents findings on conditions of healthcare delivery in Afghanistan. There is an ongoing debate about barriers to healthcare in low-income as well as fragile states. In 2002, the Government of Afghanistan established a Basic Package of Health Services (BPHS), contracting primary healthcare delivery to non-state providers. The priority was to give access to the most vulnerable groups: women, children, disabled persons, and the poorest households. In 2005, we conducted a nationwide survey, and using a logistic regression model, investigated provider choice. We also measured associations between perceived availability and usefulness of healthcare providers. Our results indicate that the implementation of the package has partially reached its goal: to target the most vulnerable. The pattern of use of healthcare provider suggests that disabled people, female-headed households, and poorest households visited health centres more often (during the year preceding the survey interview). But these vulnerable groups faced more difficulties while using health centres, hospitals as well as private providers and their out-of-pocket expenditure was higher than other groups. In the model of provider choice, time to travel reduces the likelihood for all Afghans of choosing health centres and hospitals. We situate these findings in the larger context of current debates regarding healthcare delivery for vulnerable populations in fragile state environments. The ‘scaling-up process’ is faced with several issues that jeopardize the objective of equitable access: cost of care, coverage of remote areas, and competition from profit-orientated providers. To overcome these structural barriers, we suggest reinforcing processes of transparency, accountability and participation. [Copyright &y& Elsevier]