UKRAINE Human Development Update In Focus: Disability and Inclusion February 2024 The adverse impact of Russia's invasion on persons with disabilities is the main focus of this Human Development Update. It looks at how the Government of Ukraine is strengthening the protection of vulnerable groups to ensure inclusive service delivery. Russia’s invasion of Ukraine is taking a disproportionate toll on persons with disabilities. Between 2015 and 2021, the number of persons with certified disability in Ukraine gradually increased - from 2.57 to 2.73 million people (from 6.2% to 6.7% of the pre-war population), including around 1 million women. Over a span of 18 months during the war, the number of persons with disabilities increased to 7.4% of the population (by 300,000 persons) (MoSP, September 2023). Actual numbers are likely to be close to the international disability prevalence rate of 16% (WHO, May 2023). The injuries sustained by the military and civilians can lead to devastating and long-lasting physical and psychological complications and disability. At least 10,000 civilians, including 569 children, have been killed and over 18,650, including 1,229 children, have been injured since February 24, 2022. Around 95% of the injuries were caused by explosive weapons with wide area effects (OHCHR, December 2023). Ukrainian authorities record 1,754 child casualties, including 1,226 injuries (Children of War, February 2024). The estimated number of Ukrainians who have undergone amputations since the start of the invasion is at least 20,000 (UNIAN, November 2023). The invasion triggered an unprecedented humanitarian and displacement crisis. At least 17.6 million people are currently in need of humanitarian assistance (OCHA, November 2023), including an estimated 2.6 million persons with disabilities (OCHA, February 2023). After a peak of 8 million Internally Displaced Persons (IDPs) in May 2022, over 3.67 million remain displaced within the country. Around 20% of IDP families have at least one member with a disability (IOM, October 2023). The forced displacement and damage to healthcare, social care, and education infrastructure resulted in disruptions of essential services, making it more difficult for persons with disabilities to obtain support and care or get access to education and socialization. Between February 24, 2022 and February 21, 2023, there were 1,584 attacks affecting 1,381 hospitals and other healthcare facilities (SSA, February 2024); around 13% of the education infrastructure was damaged or destroyed by the war (RDNA3, February 2024). Russia’s invasion and resulting shocks have the hardest effects on the most vulnerable. Poverty has increased from 5.5% in 2021 to 24.1% in 2022, pushing an additional 7.1 million people into poverty (World Bank, October 2023). Surveys show that around 58% of persons with disabilities report the need for financial assistance, and 20% require employment services (Rating Group, November 2023). Ukraine was one of the first post-Soviet countries that signed and ratified the UN Convention on the Rights of Persons with Disabilities (CRPD) and its optional protocols (Verkhovna Rada, December 2009). Before the invasion, the government adopted the National Action Plan to Implement the CRPD by 2025 (CoM, April 2021) and the 2030 Strategy for Barrier-Free Environment (CoM, April 2021) and passed a range of legal acts for essential social protection and rehabilitation of persons with disabilities. However, further efforts are needed to ensure that these persons can fully realize their rights as per the CRPD, which promotes disability inclusion. HD NEWSLETTER #1 December 2022 HEALTH Despite the ongoing invasion of Ukraine, the focus on inclusion and accessibility remains strong, with the aim of breaking down barriers for individuals with disabilities and facilitating access to healthcare and rehabilitation services. The procedure for obtaining or extending disability status has been streamlined for the period of martial law. Legislation has been adopted to establish remote disability assessment – regardless of the patient’s presence, place of residence/registration, or whereabouts in order to enable IDPs and refugees obtain disability status and get access to rehabilitation and support (CoM, March 8, 2022; MoH, February 2023). The individual rehabilitation programs, as well as disability and care social benefits for those with a certified disability as of February 24, 2022 were automatically extended (CoM, March 2022). The Superhumans Center for Prosthetics and Rehabilitation, Lviv oblast The government expedited the process of adoption of the WHO’s International Classification of Functioning, Disability, and Health (ICF). In April 2022, the Ministry of Economy approved the ICF as a national classification (NC 030:2022) for cross-sectoral use in disability-related programming, policymaking, and Management Information Systems (MoE, April 2022). This step has laid the basis for adopting and promoting the unified human-rights-based model of disability (MoH, September 2023). To support the transition to the ICF, the government adopted the Action Plan for reforming the Medical and Social Expert Commissions, which currently conduct disability assessment and determine disability groups focusing on impairments rather than on individual needs, adaptation, or overcoming barriers to restore quality of life. These changes would expedite the development of (i) service packages to address individual needs in healthcare, rehabilitation, social protection, education, and employment and (ii) transparent, accessible, and user-friendly mechanisms for service delivery, including using digital tools (CoM, May 2023). The Ministry of Health (MoH) has a sectoral Action Plan to support the national Strategy for a Barrier- Free Environment in Ukraine. The primary focus of the MoH is to develop an efficient system of evidence- based multidisciplinary rehabilitation. Currently, rehabilitation services are provided in 261 inpatient and 410 outpatient facilities (President of Ukraine, December 2023). The Strategy actions achieved in 2023 involved the operationalization of rehabilitation units, adoption of legislation that allows for the provision of assistive equipment to patients without the requirement of medical and social expertise or obtaining disability status, establishment of six Centers of Excellence to train rehabilitation specialists in a clinical setting (MoH, December 2023), approval of professional training standards, updating of courses curriculum, and ICF training for multidisciplinary rehabilitation teams (MDTs) (Center for Public Health, December 2023). Procurement and governance of rehabilitation services have undergone significant changes. The procurement of rehabilitation services has been reoriented by the the National Health Service of Ukraine to include inpatient and outpatient packages. Individual rehabilitation plans have been integrated into the eHealth system, allowing plans to be reviewed and revised by MDT members, with interventions coordinated across service providers (Government Portal, March 2023). The government recognizes community-based rehabilitation as a priority and set a goal to develop it in 2024 (MOH, December 2023). HD NEWSLETTER #1 December 2022 SOCIAL PROTECTION Since the beginning of Russia’s invasion, the government has introduced the following measures to strengthen the social protection of persons with disabilities: ▪ On March 7, 2022, social benefits for children with disabilities and adults disabled since childhood, children with long-term health conditions, benefits to persons who are not eligible for an old age pension and persons with disabilities, and persons providing care to those with Group I-II disabilities due to mental disorders were automatically extended without the requirement of re-enrollment (for the duration of martial law plus one month) (Cabinet of Ministers, March 2022). ▪ The social assistance program for IDPs to cover living expenses was significantly expanded on March 20, 2022 and currently School of Independent Living, Vinnytsia provides monthly support to around 2.6 million beneficiaries, including over 160,000 persons with disabilities. The benefit size is UAH 3,000 per adult with disability or a child and UAH 2,000 per adult without disability (Cabinet of Ministers, March 2022). ▪ For the duration of martial law, the enrollment in social services (including counseling and provision of shelter, supported accommodation, home-based care, inpatient care, daycare, social and psychological rehabilitation, in-kind assistance, etc.) for the elderly and persons with disabilities was simplified to allow access to services within one day based on the application only (MoSP, May 2022). ▪ In 2023, the budget for social protection of persons with disabilities was significantly increased - by 60% compared to 2022 (MoSP, February 2023). According to the State Budget for 2024, the spending will be almost doubled compared to 2023 to expand the coverage of persons with disabilities with rehabilitation and orthopedic devices and prosthetics (Government Portal, November 2023). ▪ In 2023, the implementation of the national Strategy for a Barrier-Free Environment resulted in the introduction of multidisciplinary teams, including social workers and prosthetic technicians, to ensure access to timely rehabilitation and prostheses financed by the Ministry of Social Policy (MoSP) regardless of disability status. The provision of assistive devices was aligned with the EU technical regulations; the range of the devices provided under the government programs was expanded to include high-quality items like active wheelchairs and bionic prostheses (MoSP, December 2023). In 2024, the government will compensate employers for workplace adaptations to create around 10,000 jobs for people with disabilities, removing barriers and creating opportunities for their integration in the labor market (MoE, December 2023). ▪ The DIIA platform, with almost 20 million users (MoDT, November 2023), continues to expand digital access to social services. The enrollment in 7 types of social assistance schemes is now available in DIIA, including social assistance for children with disabilities or adults disabled since childhood and social assistance for children with long-term adverse health conditions (DIIA, December 2023). ▪ In 2023, 5 types of benefits and 6 types of rehabilitation benefits and compensation directly targeted persons with disabilities and/or their caregivers. In addition, the design of another 13 benefit programs includes eligibility criteria prioritizing persons with disabilities and improving the effectiveness of social assistance provided to them (e.g., through extended benefit duration, increased benefit size, etc.) HD NEWSLETTER #1 December 2022 EDUCATION For 2024, it is estimated that 3.2 million of the 7 million Ukrainian children, including 10% of children with disabilities, will need immediate child protection services and support (Protection Cluster and UNICEF, November 2023). Children with special educational needs (SEN) have been disproportionally impacted by the invasion and access to education has been significantly disrupted. Even when schools can provide in-person classes, bomb shelters are largely inaccessible, many students lack the assistive technologies to participate in online classes, and access to specialized care and rehabilitation services is limited (Disability Rights, June 2023). Moreover, disability, institutionalization, and displacement are among the factors that continue to limit opportunities for children with SEN to acquire the skills and knowledge they need and Students of specialized school for children with hearing impairments, Kharkiv unlock their full potential. Despite the challenges faced by the country, the number of children in inclusive classes has nearly tripled since the 2018-2019 academic year. In 2022-2023, 54% of schools had inclusive classes, with 33,861 SEN students in mainstream education supported by 22,685 assistant teachers. In addition, 4,793 inclusive groups in preschools provided care to 8,483 children (MoES, August 2023). As of December 2023, the Ministry of Education and Science (MoES) has reported a 19% rise in the number of SEN students in inclusive classes in 2023-2024, totaling 40,354. Furthermore, there has been a significant 33% increase in the number of preschoolers receiving inclusive care, totaling 11,285 (MoES, December 2023). A total of 664 out of 690 inclusive resource centers (IRCs) remain operational, conducting comprehensive medical and pedagogical assessments and providing remedial and development services for children with SEN, including IDPs. The Ukraine Inclusion app enables parents to easily locate the nearest IRC, with a simplified procedure for IDP children, resulting in over 404,000 applications processed using the application (Ukraine Inclusion, December 2023). However, 37 IRCs have been damaged or destroyed (MoES, December 2023). Moreover, anecdotical evidence suggests that many IRCs lack the human and financial resources to support all children (NUS, February 2023), and parents of students with SEN report important unmet needs, especially in terms of specialized psychosocial support (Disability Rights, June 2023). The MoES developed the 2030 National Strategy for Inclusive Education Development (MoES, June 2023) and 2024-2026 Action Plan (MoES, December 2023) to be adopted after ongoing consultations. The proposed actions will help achieve the strategic goals of (i) equal access to education for children with SEN; (ii) high-quality education in a comfortable, safe, friendly, and easily accessible learning environment that caters to the needs of all students; and (iii) a society embracing diversity and prioritizing education based on individual needs (MoES, December 2023). The implementation of the Strategy is anticipated to accelerate the shift from a medical-focused approach to inclusive education to one based on human rights. HD NEWSLETTER #1 December 2022 WORLD BANK IN ACTION IN HUMAN DEVELOPMENT Russia’s invasion has taken a grave toll on Ukraine’s human capital gains. At the same time, the Government of Ukraine has shown remarkable resilience in keeping essential health, education, and social protection services functioning and adapting policy to the emergency context. This has been supported by financing and technical assistance from the World Bank. Since February 24, 2022, the Bank has provided substantial surge financing for human development through both new and repurposed lending. This included: ▪ US$90 million Additional Financing to the Ukraine Emergency COVID-19 Response and Vaccination project to finance the purchase of vaccines. ▪ Restructuring of the Improving Higher Education for Results, Serving People Improving Health, Social Safety Nets Modernization, and Eastern Ukraine: Reconnect, Recover, Revitalize (3R) projects allowed to reallocate US$300 million to finance academic and social scholarships, emergency medical equipment, and social assistance to low- income families and IDPs. ▪ A new FREE Ukraine Development Policy Operation (DPO), which eventually exceeded US$1.6 billion, provided budget support to essential services, including in human development. The Public Expenditures for Administrative Capacity Endurance (PEACE) in Ukraine project, which combines loans and grants, currently totaling over US$25.5 billion, from the World Bank and other development partners, helps to meet financing needs for the salaries of civil servants, teachers, health workers, and first Community-based social service delivery center, responders as well as finance social protection programs. Ternopil oblast In December 2022, the Health Enhancement and Life-Saving (HEAL Ukraine) project was approved. It funds essential primary care services, addresses new mental health and rehabilitation needs, provides affordable medicines, and repairs damaged clinics and hospitals. To date, the project has disbursed over US$51 million, helped provide a course of rehabilitation treatment to almost 40,000 people and mental health services to over 100,000 people, extended primary health services to over 1 million patients, delivered more than 3 million vaccine doses to children under 7, provided 3.9 million Ukrainians with free or low-cost medicines. Over 3,000 primary healthcare staff were covered by the course to address the gender-based violence. The Investing in Social Protection for Inclusion, Resilience, and Efficiency (INSPIRE) project approved in November 2023 aims to enhance the targeting, efficiency, and sustainability of the social safety net by supporting structural reform measures and financing 29 types of social assistance benefits for the most vulnerable. The INSPIRE project has disbursed US$1.2 billion to the state budget. Since February 2022, working with development partners, the World Bank has mobilized over US$41 billion in financial support to Ukraine, of which over US$35 billion has been disbursed to date (World Bank, March 1, 2024).