Source: Inclusive Education Initiative, World Bank. UNDERSTANDING MULTIDIMENSIONAL DETERMINANTS OF DISABILITY-INCLUSIVE EDUCATION: Lessons from Rwanda, Sierra Leone, and Zambia September 2022 © 2022 The World Bank 1818 H Street NW, Washington DC 20433 Telephone: 202-473-1000; Internet: www.worldbank.org Some rights reserved. This work is a product of the staff of The World Bank. The findings, interpretations, and conclusions expressed in this work do not necessarily reflect the views of the Executive Directors of The World Bank or the governments they represent. The World Bank does not guarantee the accuracy of the data included in this work. The boundaries, colors, denominations, and other information shown on any map in this work do not imply any judgment on the part of The World Bank concerning the legal status of any territory or the endorsement or acceptance of such boundaries. Rights and Permissions The material in this work is subject to copyright. Because The World Bank encourages dissemination of its knowledge, this work may be reproduced, in whole or in part, for noncommercial purposes as long as full attribution to this work is given. Attribution—Please cite the work as follows: “World Bank. 2022. Understanding Multidimensional Determinants of Disability-Inclusive Education: Lessons from Rwanda, Sierra Leone, and Zambia. © World Bank.” All queries on rights and licenses, including subsidiary rights, should be addressed to World Bank Publications, The World Bank Group, 1818 H Street NW, Washington, DC 20433, USA; fax: 202-522-2625; e-mail: pubrights@worldbank.org. 2 || UNDERSTANDING MULTIDIMENSIONALDETERMINANTS UNDERSTANDINGMULTIDIMENSIONAL OFDISABILITY-INCLUSIVE DETERMINANTSOF EDUCATION: DISABILITY-INCLUSIVEEDUCATION: LESSONS FROM RWANDA, SIERRA LEONE, AND ZAMBIA | 3 Source: Inclusive Education Initiative, World Bank. CONTENTS ACKNOWLEDGMENTS. ....................................................................................................................... 9 ABBREVIATIONS............................................................................................................................... 10 GLOSSARY......................................................................................................................................... 11 LIST OF TABLES................................................................................................................................12 LIST OF FIGURES...............................................................................................................................13 EXECUTIVE SUMMARY......................................................................................................................14 1. INTRODUCTION............................................................................................................................. 17 PURPOSE OF THE STUDY.......................................................................................................... 17 DETERMINANTS INFLUENCING EDUCATION OF CHILDREN WITH DISABILITIES.................18 METHODOLOGY.......................................................................................................................... 21 LIMITATIONS. ..............................................................................................................................23 2. REGIONAL SNAPSHOT: FINDINGS OF ONLINE SURVEY........................................................... 25 TYPE OF DISABILITY..................................................................................................................25 SCHOOL ATTENDANCE, ENROLLMENT, AND RETENTION......................................................25 ACCESS TO ASSISTIVE DEVICES, LEARNING MATERIALS, AND OTHER ACCOMMODATIONS. ................................................................................................................... 27 ADDITIONAL EXPENSES FOR FAMILIES AND GOVERNMENT SUPPORTS..............................29 COMMUNITY RESOURCES FOR PARENTS AND CAREGIVERS.. ................................................ 31 3. COUNTRY CASE STUDY: RWANDA...............................................................................................33 BACKGROUND. ............................................................................................................................33 TYPE OF DISABILITY..................................................................................................................34 SCREENING AND ASSESSMENT.. ...............................................................................................34 SCHOOL ATTENDANCE, ENROLLMENT, AND RETENTION......................................................35 ACCESS TO ASSISTIVE DEVICES, LEARNING MATERIALS, AND OTHER ACCOMMODATIONS. .................................................................................................................. 38 TRANSPORTATION TO SCHOOL AND COMMUNITY INFRASTRUCTURE.................................43 ACCESS TO SOCIAL BENEFITS AND SCHEMES TO SUPPORT INCLUSIVE EDUCATION. . ...... 44 PARENTAL ATTITUDES, PERCEPTIONS, AND EXPERIENCES OF DISABILITY-INCLUSIVE EDUCATION................................................................................................................................ 44 4 | UNDERSTANDING MULTIDIMENSIONAL DETERMINANTS OF DISABILITY-INCLUSIVE EDUCATION: 4. COUNTRY CASE STUDY: SIERRA LEONE..................................................................................... 51 BACKGROUND. ............................................................................................................................ 51 TYPE OF DISABILITY..................................................................................................................52 SCREENING AND ASSESSMENT.................................................................................................52 SCHOOL ATTENDANCE, ENROLLMENT, AND RETENTION..................................................... 53 ACCESS TO ASSISTIVE DEVICES, LEARNING MATERIALS, AND OTHER ACCOMMODATIONS..............................................................................................55 TRANSPORTATION TO SCHOOL AND COMMUNITY INFRASTRUCTURE................................. 61 ACCESS TO SOCIAL BENEFITS AND SCHEMES TO SUPPORT INCLUSIVE EDUCATION. . ....... 61 PARENTAL ATTITUDES, PERCEPTIONS, AND EXPERIENCES OF DISABILITY-INCLUSIVE EDUCATION.................................................................................................................................62 5. COUNTRY CASE STUDY: ZAMBIA.................................................................................................67 BACKGROUND. ............................................................................................................................ 67 TYPE OF DISABILITY................................................................................................................. 68 SCREENING AND ASSESSMENT................................................................................................ 68 SCHOOL ATTENDANCE, ENROLLMENT, AND RETENTION..................................................... 69 ACCESS TO ASSISTIVE DEVICES, LEARNING MATERIALS, AND OTHER ACCOMMODATIONS.............................................................................................. 72 TRANSPORTATION TO SCHOOL AND COMMUNITY INFRASTRUCTURE.................................78 ACCESS TO SOCIAL BENEFITS AND SCHEMES TO SUPPORT INCLUSIVE EDUCATION. . .......78 PARENTAL ATTITUDES, PERCEPTIONS, AND EXPERIENCES OF DISABILITY-INCLUSIVE EDUCATION................................................................................................................................. 79 6. CONCLUSION AND RECOMMENDATIONS.................................................................................. 85 REFERENCES..................................................................................................................................... 89 APPENDIX A: DETAILED METHODOLOGY...................................................................................... 95 APPENDIX B: RWANDA–LIST OF POLICIES RELATED TO INCLUSIVE EDUCATION.. ................... 99 APPENDIX C: SIERRA LEONE–LIST OF POLICIES RELATED TO INCLUSIVE EDUCATION..........101 APPENDIX D: ZAMBIA–LIST OF POLICIES RELATED TO INCLUSIVE EDUCATION.................... 102 LESSONS FROM RWANDA, SIERRA LEONE, AND ZAMBIA | 5 6 | UNDERSTANDING MULTIDIMENSIONAL DETERMINANTS OF DISABILITY-INCLUSIVE EDUCATION: ACKNOWLEDGMENTS This report is a global knowledge product from the World Bank’s Disability-Inclusive Education in Africa Program with funding provided by the Ofce of Sustainable Development, Bureau for Africa, U.S. Agency for International Development, under the terms of Award No. AID-AFR-IO-17-0001. The opinions expressed in this publication are those of the author(s) and do not necessarily refect the views of the U.S. Agency for International Development. The study was conducted by a World Bank team led by Charlotte McClain-Nhlapo (Global Disability Advisor and Lead Social Development Specialist, World Bank) and Deepti Samant Raja (Social Development Specialist), with signifcant contributions (in alphabetical order) from Anna Hill Martin (Consultant), Lisha Almeida (Consultant), Patrick Ojok (Consultant and Head of Department, Community & Disability Studies, Kyambogo University), and Ruchi Kulbir Singh (Extended Term Consultant). This study also benefted from a close review and early contributions from Colleen Howell (Consultant). Pan African Research Services Limited, based in Kenya, conducted the data collection and preliminary data analysis. The University of Rwanda-College of Education (UR-CE), under the guidance of Dr. Evariste Karangwa, served as a research partner in Rwanda. The team sincerely thanks our peer reviewers Gloria Malia Mahama (Senior Social Development Specialist), Hanna Katriina Alasuutari (Global Thematic Lead for Inclusive Education and Senior Education Specialist), Lillian Mutesi (Education Specialist), and M. Yaa Pokua Afriyie Oppong (Sector Leader). We sincerely thank the Ministry of Education, Rwanda and the National Council of Persons with Disabilities, Rwanda; the Ministry of Basic and Senior Secondary Education, Sierra Leone; and the Ministry of Education, Zambia for their approval for this study and support for the data collection processes. We are indebted to guidance, inputs, and support throughout the study from Abs Dumbuya (Consultant), Afra Rahman Chowdhury (Consultant), George Bob Nkulanga (Senior Social Development Specialist), Girma Woldetsadik (Senior Education Specialist), Gloria Malia Mahama (Senior Social Development Specialist), Himdat Iqbal Bayusuf (Education Specialist), Huma Kidwai (Senior Education Specialist), Isata Mahoi (Consultant), Lillian Mutesi (Education Specialist), Marcela Gutierrez Bernal (Education Specialist), Mari Shojo (Senior Education Specialist), Mupuwaliywa Mupuwaliywa (Consultant), and Nalin Jena (Senior Education Specialist). The team is grateful for strong support for country case studies from Rolande Pryce (Country Manager), Helene Carlsson Rex (Practice Manager, Social Sustainability and Inclusion), Muna Salih Meky (Practice Manager, Education), and Helen Mbao (Senior Operations Ofcer). This work was undertaken under the excel¬lent guidance and strong support of Louise J. Cord (Global Director Social Sustainability and Inclusion Global Practice), Ingo Wiederhofer (Practice Manager, Social Sustainability and Inclu¬sion Global Unit), and Senait Nigiru Assefa (Practice Manager, Social Sustainability and Inclu¬sion, West and Central Africa). The team is deeply grateful for their leadership in advancing inclusion for children with disabilities. Graphic Design and Page Layout by Carlos Plaza Design Studio. LESSONS FROM RWANDA, SIERRA LEONE, AND ZAMBIA | 7 ABBREVIATIONS AT assistive technology CFM Child Functioning Module CRPD Convention on the Rights of Persons with Disabilities COVID-19 Coronavirus Disease 2019 DESA Department of Economic and Social Affairs GPE Global Partnership for Education ICT information and communication technology KII Key Information Interview LMIC low-and-middle-income Country MINALOC Ministry of Local Government, Republic of Rwanda MINEDUC Ministry of Education, Republic of Rwanda UN United Nations NCPD National Council of Persons with Disabilities NGO non-governmental organization NUDOR National Union of Disability Organizations in Rwanda PARS Pan African Research Services OPD organizations of persons with disabilities SNE and IE Special Needs Education and Inclusive Education UN United Nations UNESCO United Nations Educational, Scientific and Cultural Organization UNICEF United Nations Children’s Fund USAID United States Agency for International Development UNZA University of Zambia WHO World Health Organization 8 | UNDERSTANDING MULTIDIMENSIONAL DETERMINANTS OF DISABILITY-INCLUSIVE EDUCATION: GLOSSARY There are often overlaps and interchangeability in terminology used when discussing education of children with disabilities and related accommodations. The list below describes what this report means when using specific terms. Adapted teaching and learning materials. These materials change how content is delivered and disseminated such that it can be used by children with different types of disabilities. Assistive devices. Aligns with the WHO (World Health Organization) (2016) definition of assistive products which are “any external product (including devices, equipment, instruments, or software), especially produced or generally available, the primary purpose of which is to maintain or improve an individual’s functioning and independence, and thereby promote their well-being.” Assistive technology (AT). AT is defined by the WHO (2016, 1) as “the application of organized knowledge and skills related to assistive products, including systems and services.” Inclusive education. A process of strengthening the capacity of the education system to ensure equity and inclusion in the forms of educational access, participation, and achievement for all learners. Disability-inclusive education. This term is used to reiterate the focus on disability while supporting and promoting inclusive education as articulated in Article 24 of the Convention on the Rights of Persons with Disabilities (CRPD). It emphasizes the process of ensuring that children with disabilities attend, participate and ultimately benefit from learning in school. Regular school. Implies a mainstream or neighborhood school within the general education system. In this report, regular schools include those where children with disabilities study in the same classrooms as children without disabilities. Special school. Implies a segregated or separate school designed or used to respond to a particular impairment or to various impairments, in isolation from students without disabilities (aligned with General Comment on Article 24 of CRPD). Usually, special schools are designated for certain types of disabilities. Integrated school. As articulated in the General Comment, “integration is the process of placing persons with disabilities in existing mainstream educational institutions with the understanding that they can adjust to the standardized requirements of such institutions.” In this report, an integrated school implies that children with disabilities learn in a special class or unit within a mainstream school, but not with children without disabilities. LESSONS FROM RWANDA, SIERRA LEONE, AND ZAMBIA | 9 LIST OF TABLES Table 1.1: District Selection for Study Sample...................................................................................................................19 Table 1.2: Sample for country case studies....................................................................................................................... 20 Table 2.1:  Top Five Reasons for Missing School for Extended Periods by Domain of Functional Difficulty (Regional Survey) (%).............................................................................................................................................24 Table 2.2: Categories of Assistive Devices (Regional Survey)(%)................................................................................. 26 Table 3.1: Top Three Reasons for Absence from School by Domain of Functional Difficulty (Rwanda) (%)....... 34 Table 3.2: Personal Care Assistance in Day-to-Day Activities (Rwanda) (%)............................................................. 38 Table 3.3: Perceptions of Community Accessibility (Rwanda) (%)................................................................................ 41 Table 3.4: Top Three Barriers to Accessing Benefit Schemes (Rwanda) (%)...............................................................42 Table 3.5: Recommended Actions to Increase Parent/Caregiver Involvement in Education (Rwanda) (%)...... 44 Table 3.6: Inclusion in School Activities by Domain of functional difficulty (Rwanda) (%)................................... 45 Table 4.1: Personal Care Assistance in Day-to-Day Activities (Sierra Leone) (%)......................................................55 Table 4.2: Perceptions of Community Accessibility (Sierra Leone) (%)........................................................................59 Table 4.3: Top Three Barriers to Accessing Benefit Schemes (Sierra Leone) (%)..................................................... 60 Table 4.4:  Recommended Actions to Increase Parent/Caregiver Involvement in Education  (Sierra Leone) (%)..................................................................................................................................................62 Table 4.5: Inclusion in School Activities by Domain of functional difficulty (Sierra Leone) (%).......................... 63 Table 5.1: Top Three Reasons for Absence from School by Domain of Functional Difficulty (Zambia) (%)........ 68 Table 5.2: Personal Care Assistance in Day-to-Day Activities (Zambia) (%)...............................................................72 Table 5.3: Perceptions of Community Accessibility Zambia (%)....................................................................................76 Table 5.4: Top Three Barriers to Accessing Benefit Schemes Zambia (%)................................................................... 77 Table 5.5: Recommended Actions to Increase Parent/Caregiver Involvement in Education (Zambia) (%)........79 Table 5.6: Inclusion in School Activities by Domain of Functional Difficulty (Zambia) (%)................................... 80 Table A.1: Stakeholder Groups...............................................................................................................................................93 Table A.2: District Selection for Study Sample................................................................................................................. 94 Table A.3: Distribution of Survey Participants.................................................................................................................. 94 Table A.4: KII Sample in Each Country................................................................................................................................ 96 10 | UNDERSTANDING MULTIDIMENSIONAL DETERMINANTS OF DISABILITY-INCLUSIVE EDUCATION: LIST OF FIGURES Figure 2.1: Children with Functional Difficulties (Regional Survey) (%).......................................................................23 Figure 2.2: Reasons Children were Never Enrolled in Primary School (Regional Survey) (%)................................25 Figure 2.3: Barriers to Accessing Assistive Devices (Regional Survey) (%)..................................................................27 Figure 2.4: Additional Costs by Domain of Functional Difficulty (Regional Survey) (%)......................................... 28 Figure 3.1: Children with Functional Difficulties (Rwanda) (%).......................................................................................32 Figure 3.2: Type of School Attended by Children with Disabilities (Rwanda) (%).................................................... 34 Figure 3.3: School Retention Rates (Rwanda) (%)............................................................................................................ 36 Figure 3.4: Gap between Use of and Need for Assistive Devices (Rwanda) (%).........................................................37 Figure 3.5: Additional Costs by Domain of Functional Difficulty (Rwanda) (%)......................................................... 40 Figure 3.6: Aspirations and Expectations for their Child’s Education (Rwanda) (%)................................................43 Figure 3.7: Confidence in Ability to Ensure School Meets Child’s Needs by Type of School (Rwanda) (%)........ 44 Figure 4.1: Children with Functional Difficulties (Sierra Leone) (%)............................................................................. 50 Figure 4.2: Type of School Attended (Sierra Leone) (%).................................................................................................. 51 Figure 4.3: School Retention Rates (Sierra Leone) (%)....................................................................................................52 Figure 4.4: Gap between Use of and Need for Assistive Devices (Sierra Leone) (%)................................................53 Figure 4.5: Children with Functional Difficulties Lacking Accommodations/Modifications for Learning Needs (Sierra Leone) (%).................................................................................................................. 56 Figure 4.6: Children Receiving Accommodations/Modifications for Learning Needs, by Regular or Special School (Sierra Leone) (%).....................................................................................................................57 Figure 4.7: Additional Costs by Domain of Functional Difficulty (Sierra Leone) (%)................................................ 58 Figure 4.8: Aspirations and Expectations for Child’s Education (Sierra Leone) (%)................................................ 60 Figure 4.9: Confidence in Ability to Ensure School Meets Child’s Needs, by Type of School (Sierra Leone) (%).................................................................................................................................................61 Figure 5.1: Children with Functional Difficulties (Zambia) (%)....................................................................................... 66 Figure 5.2: Reasons Children were Never Enrolled in Primary School (Zambia) (%)................................................67 Figure 5.3: Type of School Attended (Zambia) (%)........................................................................................................... 68 Figure 5.4: School Retention Rates (Zambia) (%)............................................................................................................. 69 Figure 5.5: Gap between Use of and Need for Assistive Devices (Zambia) (%)..........................................................70 Figure 5.6: Children with Functional Difficulties Lacking Accommodations/Modifications for Learning Needs Zambia (%)..............................................................................................................................73 Figure 5.7: Children Receiving Accommodations/Modifications for Learning Needs by Regular or Special School (Zambia) (%)..............................................................................................................................73 Figure 5.8: Additional Costs by Domain of Functional Difficulty (Zambia) (%)..........................................................75 Figure 5.9: Aspirations and Expectations for Children’s Education (Zambia) (%).....................................................78 Figure 5.10: Confidence in Ability to Ensure School Meets Child’s Needs by Type of School (Zambia) (%)........79 LESSONS FROM RWANDA, SIERRA LEONE, AND ZAMBIA | 11 EXECUTIVE SUMMARY It has long been recognized that multiple factors, including those outside of the school system, play a significant role in shaping educational attainment. Social, economic, and community-level factors can influence the educational participation, progress, and learning outcomes of children with disabilities. On average, globally, children with disabilities have lower levels of primary school readiness, are more likely to be out of school, and when in school, are at higher risk of dropping out than children without disabilities. There are significant disparities in educational participation and achievement between children with and without disabilities in Sub-Saharan Africa, with past studies showing gaps of up to 10 percentage points. Children with disabilities undoubtedly face barriers within the education system, however they also face significant challenges within the broader ecosystem that can significantly undermine their and their family’s ability to pursue educational opportunities on par with their peers without disabilities. This study aimed to understand what key determinants beyond school-based factors shaped the experiences of children with disabilities and their families’ ability to support their educational participation in primary school through case studies in Rwanda, Sierra Leone, and Zambia. The report also includes findings from a short regional survey of parents’ and caregivers’ perceptions across Sub-Saharan Africa. The study explored factors such as (1) parental aspirations and involvement in their child’s education; (2) stigma and attitudes about children with disabilities; (3) access to necessary supports such as assistive devices, learning materials, and personal assistance; (4) additional and out-of-pocket costs borne by families to support the educational participation of children with disabilities as compared to children without disabilities; (5) accessibility of community infrastructure and transportation; and (6) financial resources and government benefits available to families to support their child’s education. The main findings of the study are summarized below. Parents and caregivers believe in their child’s right to education and have high aspirations for their child’s education. Most hoped that their children with disabilities would complete university level or tertiary education. The study sample covered children with disabilities in regular schools with children without disabilities. Parents and caregivers perceive low support from their communities, and attribute this to stigma and negative stereotypes about children with disabilities. Children with disabilities continue to face significant gaps in obtaining an inclusive learning experience. Most children with disabilities in the study did not have access to reading and learning materials in adapted formats or personal assistance with their disability-related needs, especially at school. Children with disabilities enjoy greater inclusion in academic activities than in social, recreational, and extracurricular activities including sports, field trips, clubs, and the arts. Children with intellectual, cognitive, and psychosocial disabilities face higher rates of exclusion. Access to and use of assistive devices remains low among children with disabilities who need them. The study shows that nongovernmental organizations (NGOs) and families are the key providers and financers of assistive devices. Few children with disabilities in the study sample received devices through public sources or with government funding. These often include crucial devices such as hearing or communication aids. Mobility devices were the highest category of devices used by the children included in this study. 12 | UNDERSTANDING MULTIDIMENSIONAL DETERMINANTS OF DISABILITY-INCLUSIVE EDUCATION: Families of children with disabilities grapple with several additional and out-of-pocket expenses that would not arise for a child without a disability. These include, but are not limited to, the costs of adapted learning materials, accessible transportation, assistive devices, and personal care assistants. These expenses are often predominant reasons children with disabilities drop out of school or do not attend school for extended periods. Inaccessibility of community infrastructure and lack of resources keep children out of school. Long distances and lack of accessible transportation to school, unaffordability of the additional costs of disability-related needs, and the high costs of school expenses—often in the form of hidden costs—were linked to families’ decisions to keep their children out of primary school. Families of children with disabilities have low confidence about ensuring that their children’s needs are met and lack information and awareness about social benefits programs and schemes. Targeted outreach and sensitization programs could help bridge the knowledge gap. The findings also raise the need to adjust the amounts and eligible expenditures of social benefits to incorporate the extra costs of buying assistive devices and costs, securing transportation, or acquiring personal care assistance. The study concludes with the following recommendations on investments and interventions in the social and community ecosystem that can improve the education participation and outcomes of children with disabilities: Governments need to invest in developing assistive technology service delivery systems and • rehabilitation services. These investments should include human resources to assess and match a child with the appropriate technology or device; train children, families, and teachers in using the devices; and support maintenance or replacement of the devices. These should also include investments in human resources and rehabilitation services, such as speech therapy or physical therapy, to meet the differing needs of children with disabilities.  ccessible public transportation and barrier-free environments in communities are essential to realizing •A the right to education for children with disabilities. Coordinated actions across ministries responsible for disability issues, education, urban development, and transportation are required to promote a whole- systems approach to disability-inclusive education. Higher-level inter-ministerial collaboration is needed to deliver a holistic ecosystem-wide approach to • inclusive education so that children with disabilities can access learning related accommodations and personal care assistance at home and school to optimize their continuity of learning and accommodations across the environments they inhabit. Social protection programs, including cash transfers, education stipends, and disability benefits, can • play a significant role in reducing the high costs that families face to support the educational needs of children with disabilities. Government stakeholders must assess the additional out-of-pockets costs borne by families at country level and design social benefit programs to address these costs, thus relieving the disproportionate monetary impacts on households of children with disabilities. Parents and caregivers need adequate opportunities to be informed, involved, and included in their • children’s education. Governments, development practitioners, and civil society can offer targeted outreach, sensitization, and awareness-raising programs so that families are knowledgeable about what resources can benefit their children and how to acquire them. LESSONS FROM RWANDA, SIERRA LEONE, AND ZAMBIA | 13 1 14 | UNDERSTANDING MULTIDIMENSIONAL DETERMINANTS OF DISABILITY-INCLUSIVE EDUCATION: Source: Jonathan Ernst, World Bank. 1 1. INTRODUCTION Nearly 240 million children in the world today between the ages of 0 and 17 have some form of disability. Among children under 17 years in Sub-Saharan Africa, 10 percent in Eastern and Southern Africa and 15 percent in West and Central Africa have one or more functional difficulties (UNICEF, 2021). The UNESCO Institute of Statistics estimates that education exclusion is highest in Sub-Saharan Africa, with out-of-school rates around 20 percent for children 6–11 years, 33 percent for children 12–14 years, and 60 percent for children 15–17 years. On average globally, children with disabilities have lower levels of primary school readiness, are more likely to be out of school, and when in school, are at higher risk of dropping out than children without disabilities (UNICEF, 2021). In Sub-Saharan Africa, the likelihood of a child aged 12 having ever enrolled in school was 10 percentage points lower for children with disabilities than for children without disabilities, a gap that has only increased over time (Wodon et al., 2018). Excluding children with disabilities from education has a detrimental impact on human capital. Household earnings survey data suggests that the returns to education for individuals with disabilities are large and similar in magnitude to those observed for individuals without disabilities (Wodon et al.). Each additional year of schooling completed by an adult with a disability reduced the probability that their household will belong to the poorest two quintiles by 2 percent to 5 percent (International Labour Organization, 2015). Factors within and outside the education system can impact a child’s ability to go to school and receive the support and resources required for successful learning outcomes. The role of social factors, or factors outside of the school system in shaping educational attainment has long been recognized (Coleman, 1988; Coleman, 1968). A recognition of the role that social factors play in influencing school attainment provides decision makers and education stakeholders with a holistic understanding of investments and interventions in the wider ecosystem that can aid in improving the education participation and outcomes of children with disabilities (Chatzitheochari & Platt, 2018). Non-school barriers persist throughout the school cycle and influence students’ educational achievements in several ways and magnitudes. These factors may also impact children with diverse types of disabilities differently, which is an important consideration in designing services that address the educational needs of children across the spectrum of disability. PURPOSE OF THE STUDY This study aimed to better understand the prevailing social determinants (including cultural and economic) that affect access by children with disabilities to quality, inclusive education at the primary level in Sub-Saharan Africa, with a specific focus on Rwanda, Sierra Leone, and Zambia. These include (1) parental aspirations and involvement in their child’s education; (2) stigma and attitudes about children with disabilities; (3) access to necessary supports such as assistive devices, learning materials, and personal assistance; (4) additional and out-of-pocket costs borne by families to support the educational participation of children with disabilities as compared to children without disabilities; (5) accessibility of community infrastructure and transportation; and (6) financial resources and government benefits available to families to support their child’s education. The report shares findings from regional data collected from parents and caregivers across Sub-Saharan Africa (chapter 2), and three mixed-methods country case studies in Rwanda (chapter 3), Sierra Leone (chapter 4) and Zambia (chapter 5). The study used the UNICEF-Washington Group’s Child Functioning Module (CFM) for disability disaggregation, to learn from the experiences of children with disabilities across all types of disabilities. LESSONS FROM RWANDA, SIERRA LEONE, AND ZAMBIA | 15 DETERMINANTS INFLUENCING EDUCATION OF CHILDREN WITH DISABILITIES Social determinants of education can be categorized (1) according to the level at which they operate (individual, family, community, and macro level factors) and (2) according to the ways in which they moderate the demand for and supply of education. Often, they do not act in isolation to influence school achievement and may serve to amplify the impacts of different barriers. This chapter covers several distinct factors identified through a literature review, with a focus on studies from the African region. PARENTAL INVOLVEMENT AND ASPIRATIONS According to Article 24 of the Convention on the Rights of Persons with Disabilities (CRPD), parent and caregiver involvement and parent–teacher partnerships are an important requirement and asset in the education of children with disabilities (United Nations, 2006). Parental involvement is a positive driver of successful educational outcomes for children with disabilities, especially when there is strong collaboration and a healthy partnership between parents and educators (Afolabi, 2014). However, parents and caregivers of children with disabilities often face barriers in being equal partners with educators. A study from Mozambique found that parents of children with disabilities who are in special school placements are not given adequate opportunities to be involved in their children’s education and are not kept informed of their children’s progress or needs (Mattingly & Ratsifandrihamanana, 2016). Similarly, cultural norms and power differentials or lack of information about inclusive education policies and benefits inhibit parents and caregivers from advocating for or making decisions about their child’s learning pathways (Brittanny & Joshi, 2017; Taderera & Hall, 2017). Parents of children with disabilities are more likely to have low educational expectations of their children, something that is not limited to low-income economies. Using data on 9-year-old and 13-year-old children from a national longitudinal study of children in Ireland, Banks, et al. (2017) found that having a disability, and in particular, having a learning or intellectual disability, has impacts on parents’ long-term educational expectations for their child. Parental academic expectations are important for both young people’s self- concept and the extent to which they disliked school. Where parental academic expectations were lower, the students have a lower probability of liking school and a poorer self-concept, which in turn impacts their performance (Chartztheochari, 2018). Parental expectations also affect investment in the education of children with disabilities. Some parents of children with disabilities were unwilling to fund their children’s education because they do not see the value of educating persons with disabilities. This may lead a child with disability to drop out of school despite having interest in school and being in good academic standing (Afoakwah & Dauda, 2016). Banks et al. (2017) found that mothers’ education levels were the strongest predictor of low performance at age 13. Adolescents whose mothers achieved lower secondary education or less were between 2.2 and 2.4 times as likely to be low performers in numeric ability at age 13 (2013). In Ghana, Afoakwah and Dauda, (2016) found that for the students with disabilities, mothers’ education levels positively predicted children’s education, but fathers’ education levels had no significant effect. However, among persons without disabilities, both parents’ education positively predicted children’s education. The education levels of parents also shape the value they attach to children’s education and the amount of time they spend with their children (Afoakwah, C., & Dauda, F. 2016). The amount of parents’ time spent with children is a form of social capital investment as it allows the transfer of parental values and knowledge to their children. 16 | UNDERSTANDING MULTIDIMENSIONAL DETERMINANTS OF DISABILITY-INCLUSIVE EDUCATION: STIGMA, ATTITUDES, AND COMMUNITY PERCEPTIONS Communities can positively or negatively influence educational attainment. Positive school-community relationships help mobilize resources from the parents and the community, and some of the resources a school requires may be donated by the parents, alumni, and business community or other support groups within a community (Nyoni, Nyoni, and Bonga, 2017). Supportive communities could be drivers of social support systems for children with disabilities and their families, helping lessen and mitigate stigma and other negative beliefs about disabilities. Sociocultural barriers, such as attitudes, stigma, and discrimination, limit educational opportunities for persons with disabilities. In the Global Partnership for Education’s (GPE) (2018) review of education sector plans, negative attitudes were the second most prevalently cited barrier undermining the education of children with disabilities. Stigma, attitudes, and discrimination can differ based on the nature, severity, and onset of a disability. Inguanzo (2017) reports that a child who is born with a disability is more likely to be viewed as a result of a curse or sinful actions of the parents. Parents’ and teachers’ attitudes are likely to determine whether a child will go to a mainstream or special school. In a comparative study between Finnish and Zambian teachers on their attitudes toward inclusive or segregated learning, Finnish special education teachers were supportive, while regular teachers were critical of inclusion. While Zambian teachers preferred segregated education for all children with disabilities (Moberg, 2003). ACCESS TO ASSISTIVE DEVICES, LEARNING MATERIALS, AND OTHER ACCOMMODATIONS The World Health Organization (2018) estimates that about one billion people in the world need assistive technology services and products, but 90 percent of them do not have access to it. The gaps in access to assistive technologies only widened as a result of the COVID-19 pandemic, when many students who were accessing technologies at school were forced to stay at home. A survey of assistive technology for children with disabilities conducted by United Nations Children’s Fund (UNICEF) in 54 countries found that only about 5 percent to 15 percent of assistive technology needs are met, and low-technology assistive devices are more commonly used than high-technology assistive devices in developing countries. The study also reported that in developing countries, assistive technology services and products are provided mostly by NGOs or organizations of persons with disabilities (OPDs) (54 percent), family (48 percent), and governments (38 percent) (Rohwerder, 2018). Affordability and lack of financial support substantially limit the availability, maintenance, access, and use of assistive technology in low-income countries. The lack of affordability means that there is a high need but low uptake of assistive technology among beneficiaries, families, caregivers, and providers (Tangcharoensathien, Witthayapipopsakul, Viriyathorn, & Patcharanarumol, 2018). The cost of assistive devices can be prohibitive not only for the family or individual (World Bank, 2022), but also for the school (Ahmad, 2015), and this may result in limited availability and/or forfeiture of certain essential assistive technology such as screen readers, voice recognition software and joysticks that children need for effective learning. Forfeiture of an essential assistive technology product, like a screen reader for a child with visual impairment, can have an adverse impact on a child’s academic achievement. Many persons with disabilities and their family members lack awareness of appropriate assistive devices and services and how or from where to procure them (Botelho, 2021; Tangcharoensathien et al.; UNICEF, 2018). As per the UN Report on Disability and Development (UN DESA (Department of Economic and Social Affairs), 2018), based on existing globally comparable data, only 41 percent of countries provide accessible learning materials and 33 percent provide accessible physical environments for children with disabilities. LESSONS FROM RWANDA, SIERRA LEONE, AND ZAMBIA | 17 ADDITIONAL OUT-OF-POCKET EXPENSES FOR FAMILIES Families of children with disabilities often face hidden costs or additional costs of supporting their child’s education, exacerbating existing socioeconomic barriers. These costs may include the need to hire personal care assistants, procure assistive devices, secure accessible transportation, and accommodations for learning or physical needs (Cote, 2021; Mitra, Palmer, Kim, Mont & Groce, 2017). Parents of children with disabilities may have to forego work to care for the child, resulting in economic hardship for the family (Miller, et al., 2016). Extra costs that persons with disabilities incur are often generated by the inaccessibility of existing services, such as public transportation, documents in inaccessible formats, and other social amenities (United Nations, 2018). Families, relatives, and caregivers of persons with disabilities in low-and-middle-income countries (LMIC) bear a substantial burden of providing assistive technology for children with disabilities since government spending on assistive technology is, evidently, low. COMMUNITY INFRASTRUCTURE AND TRANSPORTATION The distance from home to school influences the child’s school participation in different ways. The distribution of schools in a community determines the time it takes to get to and from school; how the child gets to school; the availability of accessible transportation; and the cost of getting to school, including additional costs to account for accessibility, the safety precautions necessary, as well as whether a child can attend a day school or a boarding school. For some children with disabilities, these factors determine whether they will be able to attend school or not (Mattingly and Ratsifandrihamanana, 2016). FINANCIAL RESOURCES AND GOVERNMENT BENEFITS Social protection schemes and benefits can play an important role in reducing the economic barriers and direct costs experienced by families of children with disabilities (Cote, 2021). However, disability funding schemes are relatively rare in some communities and countries. Existing funding schemes are often prone to funding cuts or they are inadequate to meet the day-to-day extra costs specific to disability (Chiwandire & Vincent, 2019). When financial support is available, it may not cover costs associated with the educational needs of children with disabilities. Families may also face hurdles in applying for and receiving disability certifications or disability IDs, which may be mandatory requirements to apply for benefits (Cote). Lack of accessible infrastructure, low awareness, and additional costs of transportation and personal assistance to apply for benefits are major roadblocks for persons with disabilities in accessing ID services (World Bank, 2020). This makes it difficult for children with disabilities to access and participate in social protection programs, as the additional costs required to access them are not considered. Financial support to programs relating to children with disabilities are often philanthropic and donor-funded, which might not be sustainable for continuation by governments (Mattingly and Ratsifandrihamanana, 2016). 18 | UNDERSTANDING MULTIDIMENSIONAL DETERMINANTS OF DISABILITY-INCLUSIVE EDUCATION: METHODOLOGY The study used a mixed methods approach with a combination of qualitative and quantitative methods (see Appendix A for detailed methodology). A regional online survey of parents and caregivers of children with disabilities: The anonymous online 1.  survey targeted parents and caregivers of children with disabilities across Sub-Saharan Africa. The survey was conducted online in English, French, and Portuguese. Data from 178 respondents identifying as parents or primary caregivers of children with disabilities are captured in this report. Country case studies: The mixed methods case studies in Rwanda, Sierra Leone, and Zambia included 2.  • A literature review of the policy and legislative environment for inclusive education. An in-depth quantitative survey of parents and caregivers of children with disabilities in primary school • or of primary school age. The survey included parents and caregivers with children currently in school, as well as those whose children had never attended or dropped out of primary school. This allowed the study to capture barriers to school attendance. • Key informant interviews (KIIs) in Rwanda, Sierra Leone, and Zambia with multiple stakeholders, including government representatives, school administrators from regular and special schools, itinerant teachers, OPDs, and community-based inclusive development centers (formerly known as community-based rehabilitation (CBR) centers). Country-based data collection was conducted in three provinces or regions per country, with each district located in a different region of the country (table 1.1). Each district was chosen with the inputs of government officials and local partners and included a combination of urban, peri-urban, and rural areas. Questionnaires were translated into local languages. Respondents were selected with the assistance of World Bank country teams, the Ministries of Education, and local OPDs. Appropriate research permissions and ethics approvals were obtained in all three countries. Table 1.1: District Selection for Study Sample PROVINCE/REGION DISTRICT TARGET POPULATION RWANDA Southern province Huye Rural Kigali City Kigali Urban & peri-urban Western province Rubavu Urban & rural SIERRA LEONE Western province Freetown Urban & peri-urban Southern province Bo Urban & rural Eastern province Kenema Rural ZAMBIA Lusaka Lusaka Urban & peri-urban Copperbelt province Kitwe Urban & rural Western province Kaoma Rural LESSONS FROM RWANDA, SIERRA LEONE, AND ZAMBIA | 19 Table 1.2 illustrates the final sample for the case studies. Table 1.2: Sample for Country Case Studies RESPONDENT CATEGORY ZAMBIA SIERRA LEONE RWANDA QUANTITATIVE SURVEY WITH PARENTS AND CAREGIVERS OF CHILDREN WITH DISABILITIES Total number of respondents with children with disabili- 379 162 271 ties in primary school, or primary school going age Number of respondents with children enrolled in school 120 141 138 at the time of data collection QUALITATIVE INTERVIEWS Key Informant Interviews 21 25 23 DIVERSITY OF DISABILITY The study aimed to understand experiences of children across the diversity of disability i.e., physical, sensory, cognitive, intellectual, and psychosocial disabilities. The survey used the Child Functioning Module (CFM), developed by UNICEF (2021) and the Washington Group on Disability Statistics (2022), to disaggregate by disability. For children between the ages of 5–17 years, the CFM assesses difficulties in 11 domains of functioning: seeing, hearing, mobility, self-care, communication/comprehension, learning, remembering, attention and concentrating, relationships (making friends), coping with change, and controlling behavior, and two domains of psychosocial affect through signs of anxiety and signs of depression. REGULAR, SPECIAL, AND INTEGRATED SCHOOLS This study focused on understanding the challenges and barriers that children with disabilities face in enrolling and learning at regular schools, which are mainstream schools where children with disabilities study with children without disabilities in the same class. The study also included children with disabilities in “special” schools that are prominent across Sub-Saharan Africa, which are often segregated facilities for children with disabilities, and covered integrated schools, which are mainstream schools where children with disabilities study in a separate classroom. Traditionally, children with disabilities have studied in segregated special schools, which often cater to specific types of disabilities. 20 | UNDERSTANDING MULTIDIMENSIONAL DETERMINANTS OF DISABILITY-INCLUSIVE EDUCATION: LIMITATIONS While preparation for this study commenced before the COVID-19 pandemic, data collection was delayed due to travel restrictions across all target countries. Schools and government facilities were closed for in-person activities. The methodology pivoted to ensure health protocols were followed, and some of the KIIs were conducted virtually, resulting in shorter interviews than originally planned. It is important to note that the study questions did not focus on the impacts of COVID-19 on disability-inclusive education. Samples sizes are relatively small and cannot be used for population-level or national-level generalizations. Each country’s sample was context specifc and should not be compared across countries. The study team used purposive and selective sampling approaches, with contacts of parents and caregivers obtained through government ofcials or OPDs. This was especially due to the limitations on feld work and random sampling posed by the pandemic. The study did not collect data directly from children. Data derived from a future study using this approach would help complement observations from families and key stakeholders. The study intended to distribute the samples across urban, peri-urban, and rural areas. However, COVID-19- related travel restrictions resulted in an uneven sample with more respondents from urban and peri-urban areas than rural areas. The online distribution and digital nature of the regional survey of parents and caregivers with disabilities meant that only those with internet access could participate in the brief survey. LESSONS FROM RWANDA, SIERRA LEONE, AND ZAMBIA | 21 2 22 | UNDERSTANDING MULTIDIMENSIONAL DETERMINANTS OF DISABILITY-INCLUSIVE EDUCATION: Source: “Emelda and Vivian.Girls Education Challenge in Kenya.” Jenny Matthews, Leonard Cheshire Disability. 2 2. REGIONAL SNAPSHOT: FINDINGS OF ONLINE SURVEY This chapter presents the findings of an online survey of 178 parents and caregivers of children with disabilities across Sub-Saharan Africa. The survey was conducted to gather a regional snapshot of (1) the experiences of children with disabilities in accessing educational facilities and resources; (2) the availability of learning support, such as assistive devices, at school and at home; and (3) the needs of and resources available to support children and families. TYPE OF DISABILITY Children with functional difficulties in communicating (48 percent), learning (42 percent), and seeing (41 percent) were the dominant groups represented in the online survey. The representation of children with functional difficulties in walking (16 percent) and self-care (20 percent) was lowest in the sample. Thirty-six percent of children in the sample showed signs of anxiety, and 26 percent showed signs of depression. Figure 2.1: Children with Functional Difficulties (Regional Survey) (%) 60 PERCENTAGE OF CHILDREN WITH DIFFERENT 50 48 41 42 40 36 FUNCTIONAL DIFFICULTIES 32 30 30 28 26 26 25 25 20 20 16 10 0 Seeing Hearing Walking Self-care Communicating Learning Remembering Concentrating Accepting change Controlling behavior Making friends Signs of anxiety Signs of depression TYPES OF FUNCTIONAL DIFFICULTIES SCHOOL ATTENDANCE, ENROLLMENT, AND RETENTION The survey findings revealed that the majority of children with disabilities from this sample attended regular schools. Of the children with disabilities currently attending school (n=117), 61 percent of the children attended regular schools, 23 percent were in special schools, and 16 percent were in integrated schools. The survey asked respondents to identify the barriers preventing their children with disabilities from attending school for a period exceeding a month. The main barriers faced by parents and caregivers included long distances to school (43 percent), high school fees or other costs (37 percent), the lack of accessible transportation to school (33 percent), lack of assistance with personal care needs at school (32 percent), and the unaffordability of the additional costs to support their children’s disability-related needs (29 percent). LESSONS FROM RWANDA, SIERRA LEONE, AND ZAMBIA | 23 Table 2.1:  Top Five Reasons for Missing School for Extended Periods by Domain of Functional Difficulty (Regional Survey) (%) CONTROLLING BEHAVIOR SIGNS OF DEPRESSION ACCEPTING CHANGE SIGNS OF ANXIETY COMMUNICATION MAKING FRIENDS CONCENTRATING SELF-CARE LEARNING WALKING HEARING SEEING Distance from home to 62 60 36 33 39 44 30 11 28 41 32 68 school is too long School fees or costs were 54 65 45 75 51 56 48 58 48 41 55 43 too expensive Lack of accessible 42 50 18 33 35 37 22 16 24 47 41 53 transportation to the school Child did not receive assistance with personal 38 35 45 33 41 41 33 21 48 29 32 38 care needs at school Could not afford additional costs to support disability- 46 55 36 42 41 29 33 32 52 47 27 28 related needs 24 | UNDERSTANDING MULTIDIMENSIONAL DETERMINANTS OF DISABILITY-INCLUSIVE EDUCATION: Of the total sample of 178 respondents, 29 percent stated that their children had never attended formal primary school. Parents and caregivers identified high school fees or costs (38 percent), a lack of accessible transportation (35 percent), long distances to school (33 percent), and a lack of assistance with personal care needs at school (31 percent) as the top barriers to school enrollment (see figure 2.2). Figure 2.2: Reasons Children were Never Enrolled in Primary School (Regional Survey) (%) PERCENTAGE OF RESPONDENTS 0 10 20 30 40 REASONS FOR NOT ENROLLING IN SCHOOL Parent/caregiver concerns such as safety/bullying 29 Perceived low benefit of education 12 Awaiting school admission 2 Did not receive admission due do to disability 17 Distance from home to school is too long 33 Lack of accessible transportation to the school 35 School fees or costs were too expensive 38 No assistance with personal care needs 31 Additional costs to support disability-related needs 35 School infrastructure was not accessible 12 Child was receiving theraphy/treatment services 12 Child was in informal educational setting 12 Other 15 Note: n=52 ACCESS TO ASSISTIVE DEVICES, LEARNING MATERIALS, AND OTHER ACCOMMODATIONS Overall, 43 percent of the respondents reported that their children with disabilities who needed assistive devices did not have or use any assistive devices. Among children using assistive devices, the highest categories were speech and communication devices (23 percent) and personal mobility devices (20 percent). Table 2.2 shows the categories used by the respondents. LESSONS FROM RWANDA, SIERRA LEONE, AND ZAMBIA | 25 Table 2.2:  Categories of Assistive Devices (Regional Survey)(%) TYPE OF ASSISTIVE DEVICE (N=178) PERCENT Speech and communication (augmentative and alternative communication (AAC) devices, etc.) 23 Personal mobility devices (e.g., prosthetics, braces, orthotic devices, crutches, cane/walking stick, wheel- 20 chair/scooter) Cognitive, development, learning aids (e.g., memory aids, portable note-taking aids, recording equipment, 19 etc.) Vision aids (e.g., glasses, contact lenses, magnifier, Braille reader, screen reader, white cane, larger print 17 materials) Hearing (e.g., hearing aids, cochlear implants, amplifiers, visual/vibrating alarm, closed captioning services, 17 phone/video) Aids for daily living activities such as toileting, hygiene etc. (extenders, graspers, etc.) 17 Computing devices, software, and mobile applications 15 Seating and positioning 12 Environmental aids (e.g., visual/vibrating alarm) 6 One third of the respondents (33 percent) obtained their child’s assistive device from nonprofit organizations and community-based rehabilitation centers. Others received them from friends or family (17 percent), the private sector (11 percent), or had self-made devices (15 percent). Only 4 percent received their devices from the public sector, i.e., government facilities, public hospitals, and public schools. The dominant reason for children not having access to the assistive devices they need was the high cost of the devices (57 percent). Other barriers included a lack of awareness/knowledge about the appropriate assistive devices (37 percent) and a lack of information about where to obtain the devices (33 percent) (figure 2.3). 26 | UNDERSTANDING MULTIDIMENSIONAL DETERMINANTS OF DISABILITY-INCLUSIVE EDUCATION: Figure 2.3: Barriers to Accessing Assistive Devices (Regional Survey) (%) PERCENTAGE OF RESPONDENTS 0 10 20 30 40 50 60 Lack of awareness/knowledge about the appropiate 37 assistive devices Not knowing where to get the assisitive device 33 TYPE OF BARRIERS The location to get the devices is too far/inconvenient 11 The assistive devices are too expensive 57 It is very expensive to visit the location to receive 19 the devices The appropiate device is not available in my 19 district/country The device is broken or requires maintenance 7 Note: n=178 Over one third of the respondents (37 percent) stated that their child did not have access to reading and learning materials in accessible formats. Among those who had access, respondents identified audio (21 percent), easy read versions (20 percent), large print (19 percent), and sign language (17 percent) as some of the accessible formats their child used. ADDITIONAL EXPENSES FOR FAMILIES AND GOVERNMENT SUPPORTS The survey asked respondents about the overall additional costs they incur to support the educational participation of their children with disabilities that they would not face for a child without disabilities. The highest additional out-of-pocket expenses were for assistive devices (45 percent) followed by transportation costs for adapted or accessible vehicles (41 percent), school fees (36 percent), adapted learning materials (35 percent), and hiring personal assistants (33 percent). Figure 2.4 breaks down costs by domain of functional difficulty. LESSONS FROM RWANDA, SIERRA LEONE, AND ZAMBIA | 27 Figure 2.4: Additional Costs by Domain of Functional Difficulty (Regional Survey) (%) PERCENTAGE OF RESPONDENTS 0 10 20 30 40 50 60 70 Seeing Hearing Walking Self-care Additional transport costs related to Communicating DOMAIN OF FUNCTIONAL DIFFICULTY adapted/accessible vehicles School fees Learning Hiring cost of personal assistant Remembering Out of pocket costs of assistive technology/ device(s) Concentrating Added costs of adapted learning materials Accepting change Controlling behaviour Making friends Signs of anxiety Signs of depression Note: n=178 28 | UNDERSTANDING MULTIDIMENSIONAL DETERMINANTS OF DISABILITY-INCLUSIVE EDUCATION: Most of the respondents stated that they did not receive any government benefts to help with the costs of supporting the school participation and learning needs of children with disabilities. The dominant barrier faced by respondents in accessing government benefts is a lack of awareness/knowledge about the schemes (61 percent). Other barriers include distance to the sites ofering services (22 percent), expenses incurred in the process of receiving benefts (20 percent), a lack of accessible means of transportation (17 percent), and the behavior of ofcials (15 percent). COMMUNITY RESOURCES FOR PARENTS AND CAREGIVERS Half of the respondents (51 percent) stated that there were support groups for parents of children with disabilities within their community. Support groups were available within their immediate community (28 percent), at their child’s school (20 percent), and online (10 percent). When asked about other resources available to them, 41 percent of parents and caregivers cited primary health care centers, followed by community-based rehabilitation workers (24 percent), and peer-to-peer support groups (22 percent). LESSONS FROM RWANDA, SIERRA LEONE, AND ZAMBIA | 29 30 | UNDERSTANDING MULTIDIMENSIONAL DETERMINANTS OF DISABILITY-INCLUSIVE EDUCATION: Source: Inclusive Education Initiative, World Bank. 3 3. COUNTRY CASE STUDY: RWANDA BACKGROUND In accordance with Article 40 of Rwanda’s Constitution, every Rwandan citizen has the right to education, and primary education is free and compulsory in public schools. It states that Rwanda “has the duty to take special measures to facilitate the education of disabled people.” Rwanda ratified the CRPD in 2008. Findings from the Fourth Rwanda Population and Housing Census conducted in 2012 showed that 64 percent of children with disabilities were attending school, compared to 81 percent of children without disabilities (National Institute of Statistics of Rwanda, 2014). The census revealed that 27 percent of children with disabilities had never attended school compared to 14 percent of children without disabilities. The education census conducted for the period_2020-21 documented that only 0.8 percent of the total primary school population were learners with disabilities (Ministry of Education, Rwanda, 2022). The Revised Special Education and Inclusive Education Policy 2018 sets out a vision for inclusion and optimum participation of all categories of learners with special educational needs within the full range of educational services provided in Rwanda and, subsequently, in the general socioeconomic development of the country. The strategic goals of the Special Needs Education and Inclusive Education (SNE and IE) Policy 2018 are (1) improved access, retention, and completion of schooling, (2) development of support services through schools of excellence in special and inclusive education, (3) promotion of special needs and inclusive education quality services, and (4) promotion of inclusive and child-friendly approaches. This policy explicitly defines inclusive education as “the process of addressing all learners’ educational needs in a mainstream education setting.” However, it references special schools especially for learners with severe disabilities. The National Policy of Persons with Disabilities and Four Years Strategic Plan (2021-2024) builds on the government’s commitment to empower, support, and promote the inclusion of persons with disabilities across the country, which includes the education of children with disabilities. Appendix B offers an overview of the policy environment in Rwanda supporting the education of children with disabilities. The sections below present the findings of the case study involving 271 parents and caregivers of children with disabilities and 23 key informants. Of the responding parents and caregivers, 73 percent were female and 27 percent male. Seventy-one percent of the respondents were mothers of the child with disabilities, 24 percent were fathers, and 6 percent were other family members, such as siblings, grandparents, aunts or uncles. LESSONS FROM RWANDA, SIERRA LEONE, AND ZAMBIA | 31 TYPE OF DISABILITY Children with functional difficulties in learning represented 51 percent of all children with functional difficulties in the sample (n=271), followed by children with functional difficulties in walking, self-care, and remembering, at 42 percent each. A little under one third of the population showed signs of anxiety (27 percent) and depression (23 percent). Estimated disability prevalence in Rwanda is generally below the global estimate of 15 percent. Under 1 percent of the children ages 0–4 have some form of disability, while over 1 percent of the children ages 5–9 and about 2 percent of the children ages 10–19 have some form of disability (UNICEF, 2018). The 2020-2021 education census (MINEDUC, 2022) found that 29.3 percent of the children with disabilities in primary school had physical and motor difficulties and 29.5 percent had learning difficulties. Children with seeing difficulties represented 11 percent of primary school population with disabilities and 7 percent had hearing difficulties. It is important to note that the sample for this study was not meant to be nationally representative and was selected through purposive sampling. This can lead to differences in representation of different types of functional difficulties. Figure 3.1: Children with Functional Difficulties (Rwanda) (%) 51 PERCENTAGE OF CHILDREN WITH DIFFERENT 50 42 42 42 40 38 38 37 36 31 FUNCTIONAL DIFFICULTIES 30 27 23 20 17 15 10 0 Seeing Hearing Walking Self-care Communicating Learning Remembering Concentrating Accepting change Controlling behavior Making friends Signs of anxiety Signs of depression TYPES OF FUNCTIONAL DIFFICULTIES Note: n=271 SCREENING AND ASSESSMENT Most children in the Rwanda sample had acquired their disability at birth (59 percent), while 34 percent acquired their disability after birth but before starting school, and 6 percent acquired it after starting school. Eighty-six percent of parents and caregivers responded that their child had been screened or assessed for a disability or functional difficulty. Children with hearing difficulties (28 percent) were the largest group that had not been screened or assessed. The significant majority (95 percent) were screened or assessed at a hospital, with only 3 percent assessed at home by a community health worker and less than 1 percent assessed at school. In terms of the screenings/assessments taking place at schools, most school administrators interviewed said that the tools were either inadequate or completely unavailable to them. While some schools had partnerships with local health clinics or hospitals to which to refer students as necessary, most relied on their own observations, inputs from the parents and caregivers through admission forms, and one-on-one conversations with the parents and caregivers. Several school administrators stated that they do not have any children with disabilities in their schools, but that a lack of screening and assessment tools might be preventing them from being able to correctly identify the students that experience difficulties in various functioning areas and preclude the identification of children with invisible disabilities. 32 | UNDERSTANDING MULTIDIMENSIONAL DETERMINANTS OF DISABILITY-INCLUSIVE EDUCATION: “We do not have such [assessment/screening] tools.” (School Admin, regular school) “We have them, but they are not adequate in terms of accuracy. When results are not clear, we take our students to a nearby hospital for further investigation.” (School Admin, special school) “We have an audiology department which is in charge of assessing the level of impairment and we have a machine which helps us to identify the severity of impairment… We have only one person in charge of assessment, if he is absent, we stay helpless.” (School Administrator, School for the Deaf) Although the national disability law mandates that the Minister of Education “determine the modalities of facilitating persons with disabilities in ordinary and specialized schools in case of failure to study with others” (Article 11 of Law No 01/2007 of 20/01/2007), there was inconsistent information among stakeholders (ministry officials, OPD representation, school administrators) on the guidelines used when admitting children with disabilities to the school, whether regular or special. Special schools generally had guidelines developed by school leadership and included limitations on the ages of students that could attend as well as limitations on the functionality domains. If the school was for deaf learners, they did not want to accept learners from other disability types. Several general schools that had students with disabilities in attendance said that the guidelines used were developed by the Rwanda Education Board (REB) and a five-year UK-funded project called Building Learning Foundations. However, many stakeholders were not aware of any guidelines used across schools. According to the Revised SNE and IE Policy 2018, mainstream schools typically enroll learners with mild-to- moderate disabilities who would not require any or major adjustments in the school systems. Similarly, the Education Law of 2011 defines specialized schools as setting for children with disabilities “who cannot study in ordinary schools” (Rwanda Official Gazette, 2011). A study by MINEDUC, UNICEF and Education Development Trust (2016) confirms that many education stakeholders at all levels consider children with disabilities not to be the responsibility of mainstream schools. The proportion of children receiving screening at home was highest in the rural district of Huye (8 percent). For the majority of the children (42 percent), this was a one-time assessment, 32 percent were receiving ongoing periodic assessments, whereas 27 percent used to receive periodic assessments that were now completed. Only 30 percent of the children receive regular check-ups for their functional difficulties, and 87 percent of them receive the check-ups at a hospital. The rest receive check-ups at school (5 percent), medical camps (4 percent), or through humanitarian organizations (5 percent). These responses seem to indicate that most of the screenings and assessments are medical in nature, one off, and may not be adequately assessing the learning or educational needs of children with disabilities. This may also suggest that respondents primarily categorized screenings and assessments as medical checkups rather than functional assessments to identify learning related needs of children with disabilities as promoted by the Revised Special Education and Inclusive Education Policy 2018. SCHOOL ATTENDANCE, ENROLLMENT, AND RETENTION OUT-OF-SCHOOL CHILDREN Of the total sample of 271 respondents, 164 (61 percent) stated that their children had ever attended formal primary school. Among these 16 percent had dropped out of school at the time of the study. Based on 157 participants reporting on the sex of their child with disabilities, 67 percent of the children who have ever attended school are boys and 33 percent are girls. Of the boys in the sample, 64 percent had attended school at some point, compared with 58 percent of the girls in the sample. The main barriers faced by parents and caregivers whose children with disabilities had never attended primary school or had dropped out (n=133) were a lack of accessible transportation to school (41 percent), high school fees or costs (38 percent), and the unaffordability of additional costs to support their children’s disability-related needs (30 percent). Table 3.1 shows how these barriers may differ across disabilities. LESSONS FROM RWANDA, SIERRA LEONE, AND ZAMBIA | 33 Table 3.1: Top Three Reasons for Absence from School by Domain of Functional Difficulty (Rwanda) (%) CONTROLLING BEHAVIOR SIGNS OF DEPRESSION ACCEPTING CHANGE SIGNS OF ANXIETY COMMUNICATION MAKING FRIENDS CONCENTRATING REASONS FOR ABSENCE SELF-CARE LEARNING WALKING HEARING SEEING Lack of accessible transportation to the 41 36 48 51 40 50 52 51 53 52 55 52 school School fees or costs were 32 36 39 43 44 40 42 44 38 41 40 42 too expensive Could not afford additional costs to support disability- 23 36 36 39 43 39 42 41 38 39 38 40 related needs TYPE OF SCHOOL The majority of children with disabilities included in the survey reported going to public day schools (51 percent), followed by private day schools (28 percent), and religious day schools (13 percent). These numbers differed when compared across the urban, peri-urban, and rural areas. A significant majority were enrolled in public day schools in peri-urban areas (79 percent) and rural areas (71 percent), whereas in urban areas, 37 percent were in private day schools, followed by public (27 percent) and religious sponsored day schools (25 percent). Among boys with disabilities in the sample, 51 percent were in public day schools, 25 percent in private day schools, and 14 percent in religious sponsored schools. The numbers were slightly different for girls with disabilities, with 36 percent going to public day schools, 36 percent in private day schools, and 25 percent in religious sponsored day schools. Figure 3.2: Type of School Attended by Children with Disabilities (Rwanda) (%) 100 100 PERCENTAGE OF CHILDREN 93 90 80 80 70 63 60 50 40 30 21 20 16 9 11 10 3 3 0 0 0 Total Urban Peri-urban Rural TYPE OF SCHOOL Regular school Special school Integrated school Note: n=138 34 | UNDERSTANDING MULTIDIMENSIONAL DETERMINANTS OF DISABILITY-INCLUSIVE EDUCATION: Eighty percent of the children currently in school were attending regular schools (79 percent of boys and 71 percent of girls), 11 percent were in integrated schools (14 percent of boys and 18 percent of girls), and 9 percent were in special schools (7 percent of boys and 11 percent of girls). The highest percentage of children in special schools was observed in urban areas (21 percent), whereas almost all the children in rural (100 percent) and peri-urban (93 percent) areas were enrolled in regular schools. As stated above, it should be noted that in Rwanda, inclusive schools are generally intended for children with mild and moderate disabilities and special schools for children deemed to be unable to learn from regular schools. Less than one third of the children (28 percent) attended a school that had an inclusive education resource center to provide learning materials and support for students with disabilities, which is consistent with interviews with the Ministry of Education (MINEDUC), noting that there were very few of both resource centers and special schools across the country. OPDs and government officials suggested anywhere between 45 percent and 80 percent of the regular schools were inclusive of learners with disabilities. “The education of disabled children is still a challenge, but we are on the way, and we believe we are going to reach the set goal” (MINEDUC) “The government has started to incorporate special needs and inclusive education, however, [it is] not so good, because of a shortage of resources provided to the school or the children with disabilities. There is a lack of special schools and the mainstream schools do not always provide the necessary accommodations for children with disabilities, this led to high dropout rates.” (NUDOR) SCHOOL ENROLLMENT AND RETENTION Among the study sample, 61 percent of children with disabilities have enrolled in formal primary school at some point, but only 51 percent were still enrolled in school at the time of the study, yielding a retention rate of 84 percent. Based on those who provided the sex of their child, 67 percent of children enrolled at the time of the study were boys and 33 percent were girls similar to typical enrollment rates. Of the children with disabilities enrolled in school, nearly half (43 percent) enrolled when they were either 6 or 7 years of age, 17 percent enrolled between the ages of 8 and 10 years. This finding contradicts the literature showing that most children with disabilities are often over aged for their classes/grades due to late entry into school (Zuurmond, 2015). Enrollment rates are higher for children with sensory and physical disabilities and drop for children with cognitive, intellectual, and psychosocial disabilities. While this study did not focus on the impacts of the COVID-19 pandemic, it is important to note that the current enrollment rates were collected at a time of school closures due to the pandemic. Studies evaluating the impact of COVID-19 school closures have raised concerns about the heightened risk that students from disadvantaged groups may not return after schools reopen (World Bank, UNESCO & UNICEF, 2021). The rate of retention is calculated by dividing the number of currently enrolled students by the number of those that had ever been enrolled. Children with functional difficulties in the walking, seeing, and hearing domains recorded the highest retention rates of 87 percent, 84 percent, and 83 percent, respectively. Children with functional difficulties in the domains of making friends, learning, and controlling behavior had the lowest (Currently enrolled) Retention rate = x 100% (Ever enrolled) LESSONS FROM RWANDA, SIERRA LEONE, AND ZAMBIA | 35 Figure 3.3: School Retention Rates (Rwanda) (%) 100 87 88 84 83 87 90 78 80 77 78 79 78 80 75 71 73 72 67 68 70 60 PERCENTAGE OF CHILDREN 50 40 30 20 10 0 Learning Remembering Controlling behavior Making friends Signs of anxiety Signs of depression Kigali Communicating Self-care Concentrating Rubavu Total Seeing Hearing Walking Accepting change Huye DOMAIN OF FUNCTIONAL DIFFICULTIES DISTRICTS Note: n=164 Slightly less than half the children with disabilities (46 percent) in the sample had to repeat a grade; this included 40 percent of the boys and 54 percent of the girls among those who provided data on the child’s sex. Children with functional difficulties in hearing (61 percent) and those showing signs of anxiety (82 percent) and depression (73 percent) have the highest rates of repetition. Participants listed “not receiving passing marks in core subjects” (48 percent) and “medical reasons” (37 percent) as the top reasons for repetition. Children with functional difficulties in learning (63 percent) comprised the highest percentage of those unable to achieve passing marks, whereas children with difficulties seeing faced the most barriers due to medical reasons (70 percent). ACCESS TO ASSISTIVE DEVICES, LEARNING MATERIALS, AND OTHER ACCOMMODATIONS ASSISTIVE DEVICES In the Rwanda case study, only 14 percent of children with disabilities used assistive devices. However, 73 percent of the parents and caregivers of children who did not currently use assistive devices said their children would benefit from the use of an assistive device, signaling a significant gap between demand and supply (see figure 3.4). The literature confirms there is a high need for, but low supply of assistive devices (Tangcharoensathien et al., 2018). In terms of districts, children in the rural area of Huye (20 percent) had higher use of assistive devices than those in Kigali (15 percent) and Rubavu (6 percent). 36 | UNDERSTANDING MULTIDIMENSIONAL DETERMINANTS OF DISABILITY-INCLUSIVE EDUCATION: Figure 3.4: Gap between Use of and Need for Assistive Devices (Rwanda) (%) 100 92 90 81 83 81 80 72 75 73 71 70 71 69 70 69 70 60 50 PERCENTAGE OF CHILDREN 40 30 20 15 20 13 11 11 11 11 13 10 10 10 12 10 5 0 Signs of depression Seeing Hearing Walking Self-care Communicating Learning Remembering Concentrating Accepting change Controlling behavior Making friends Signs of anxiety DOMAIN OF FUNCTIONAL DIFFICULTIES Does your child currently use any assistive device? If not, would your child benefite from the use of an assistive device? Note: n=225 for question on current use of assistive device; n=195 for question on potential benefit from assistive device Children with difficulties in walking (20 percent) and seeing (15 percent) used assistive devices the most. Children with difficulties hearing had the lowest figure even in the reduced sample with only two children (5 percent) having access to assistive devices such as hearing aids which may be essential to their educational participation. While the significantly reduced sample size does not allow for any wide-scale interpretations, several school administrators pointed to the expense of hearing aids, which is likely preventing many from accessing them. As illustrated in figure 3.4, mobility aids and devices were the largest category of assistive devices in use, with 30 percent using wheelchairs or scooters, 19 percent using crutches, 16 percent using artificial limbs or prosthetics, and 11 percent using orthopedic footwear. In Rwanda, 54 percent of the respondents whose children are using assistive devices (n=37) obtained them from the public sector, including government facilities, public hospitals, and public schools. The remaining respondents note that 16 percent had self-made devices and that 14 percent received them from NGOs and community-based rehabilitation centers. However, since the portion of the sample using assistive devices is so small, it is difficult to make wider interpretations about access and provision of assistive devices. The National Union of Disability Organizations in Rwanda (NUDOR) and National Council of Persons with Disabilities (NCPD) both noted that assistive devices were only available to about 20 percent of the children in special schools that needed them. MINEDUC noted that while devices should be provided to any child that needs them, the request must come from the school. Several school administrators who were interviewed highlighted that the assistive devices typically came from the government and NGOs. This confirms the literature showing the cost of assistive technology can be high not only for the family or individual but also for the school (Ahmad, 2015). A teacher at a regular school mentioned that the school did not yet have any adapted materials and assistive devices for a student with a disability who might wish to enroll. LESSONS FROM RWANDA, SIERRA LEONE, AND ZAMBIA | 37 PERSONAL CARE ASSISTANCE Children with disabilities have higher rates of personal assistance at home than in school. Fifty-nine percent of the children with disabilities in the sample had someone assisting them with day-to-day activities at home, but this number dropped to 10 percent for having assistance both at home and at school. One quarter (25 percent) of the respondents said their children needed assistance but did not have it. Parents and caregivers listed the high cost of personal assistants (55 percent), followed by a lack of awareness and about personal assistants (46 percent), and not knowing where to find or hire them (43 percent) as the main reasons for the unmet need. See table 3.2 for disaggregation by type of functional difficulty. Table 3.2: Personal Care Assistance in Day-to-Day Activities (Rwanda) (%) YES NO YES NO at home but needs both at does not DOMAIN OF FUNCTIONAL DIFFICULTY only assistance home and need school assistance TOTAL (N=271) 59 25 10 7 SEEING 70 17 11 2 HEARING 50 40 3 8 WALKING 59 27 11 3 SELF-CARE 61 32 6 1 COMMUNICATION 57 30 8 5 LEARNING 59 32 6 3 REMEMBERING 54 35 8 3 CONCENTRATING 58 36 5 1 ACCEPTING CHANGE 57 34 8 1 CONTROLLING BEHAVIOR 56 36 5 3 MAKING FRIENDS 64 29 4 4 SIGNS OF ANXIETY 57 35 7 1 SIGNS OF DEPRESSION 66 26 6 2 The rates of unmet needs for personal assistance are higher in regular schools (75 percent) and integrated schools (21 percent) than in special schools (4 percent). 38 | UNDERSTANDING MULTIDIMENSIONAL DETERMINANTS OF DISABILITY-INCLUSIVE EDUCATION: ACCOMMODATIONS FOR LEARNING NEEDS Eighty-two percent of the respondents stated that their child had not received any accommodations or modifications for their learning needs in school despite needing accommodations. Only 8 percent of children in the study sample had received learning-related modifications. Access to accommodation services is extremely low in Rwanda despite Law No. 01/2007 requiring education institutions to provide accommodations for children with disabilities who cannot study or sit examinations under the same circumstances as students without disabilities. The survey sought to understand whether children with disabilities had access to reading and learning materials at home. This is important to ensure their continuity of learning and comparable access to materials at home as their peers without disabilities. Eight-six percent of the participants said their children did not have access to books at home in a format they can read, and 77 percent said their children did not have access to learning materials in preferred formats. However, 64 percent said their children were able to complete homework or study for examinations at home. The vast majority of the respondents (88 percent) said their child had access to toilets and other water and sanitation facilities at school, including for children with seeing (96 percent), walking (85 percent), and self-care difficulties (90 percent). Seventy-three percent stated their children received the help needed with accessing water and sanitation facilities, with slightly higher rates for children with seeing (78 percent), walking (77 percent), and self-care difficulties (71 percent). ADDITIONAL EXPENSES FOR FAMILIES The survey asked respondents about the overall additional costs they incur to support the educational participation of their children with disabilities that they would not face for a child without disabilities. The highest additional out-of-pocket expenses were for adapted learning materials (43 percent), followed by transportation costs for adapted or accessible vehicles (31 percent), assistive devices (22 percent), and hiring personal assistants (12 percent). Available evidence confirms that hidden costs are a barrier to education in Rwanda. The aggregate cost of non-tuition-related expenses includes higher transportation and food costs, while caring for children with disabilities incurs extra costs, such as hiring additional help like a guide or sign language interpreter or buying assistive devices. Figure 3.5 breaks down the costs by domain of functional difficulty. Parents and caregivers of children with functional difficulties in hearing (72 percent), making friends (56 percent), communication (54%), and those showing signs of anxiety (54 percent) bore the highest additional costs for adapted learning materials. LESSONS FROM RWANDA, SIERRA LEONE, AND ZAMBIA | 39 Figure 3.5 : Additional Costs by Domain of Functional Difficulty (Rwanda) (%) PERCENTAGE OF RESPONDENTS 0 20 40 60 80 Seeing Hearing Walking Self-care Additional transport Communicating DOMAIN OF FUNCTIONAL DIFFICULTY costs related to adapted/accessible vehicles Learning Hiring cost of personal assistant Remembering Out of pocket costs of assistive technology/ device(s) Concentrating Added costs of adapted learning materials Accepting change Controlling behaviour Making friends Signs of anxiety Signs of depression Note: n=138 40 | UNDERSTANDING MULTIDIMENSIONAL DETERMINANTS OF DISABILITY-INCLUSIVE EDUCATION: TRANSPORTATION TO SCHOOL AND COMMUNITY INFRASTRUCTURE The survey enquired about the participants’ perceptions of the overall accessibility of infrastructure in their communities. Seventy-three percent stated that buildings in their community were not accessible for persons/children with disabilities. Sixty-two percent stated that transportation in their community was not accessible, and 77 percent stated that there were no rehabilitation resources and services in their communities (see table 3.3). Table 3.3: Perceptions of Community Accessibility (Rwanda) (%) COMMUNITY ACCESS FEATURES DISTRICTS TOTAL (N=271) KIGALI RUBAVU HUYE Yes 18 22 10 20 J1. Are buildings in your community accessible for persons/children with No 73 73 74 71 disabilities? Don’t know 10 4 16 9 Yes 30 38 13 38 J2. Is transportation accessible? No 62 54 78 53 Don’t know 8 7 9 9 Yes 13 7 5 26 J3. Are there rehabilitative resources No 77 84 79 68 and services available in your area? Don’t know 10 9 16 7 Most children (68 percent) travelled to school on foot, while 11 percent used school-provided transportation. Children with difficulties in walking used vehicular transportation at higher rates than in all other domains of functional difficulties. Most respondents (64 percent) said they did not have additional out-of-pocket expenses for accessible transportation to school. These figures vary by domain of functional difficulty, with the most additional expenses incurred by parents and caregivers of children with difficulties in the domains of seeing (50 percent), walking (43 percent), remembering (40 percent), and of children showing signs of depression (59 percent). LESSONS FROM RWANDA, SIERRA LEONE, AND ZAMBIA | 41 ACCESS TO SOCIAL BENEFITS AND SCHEMES TO SUPPORT INCLUSIVE EDUCATION Most caregivers (69 percent), and mainly in Rubavu district, had not yet applied for a disability identification/ certification card for the child. Although, the Ministry of Local Government (MINALOC) reports on their effective use of various channels to sensitize the public about social protection programs, NUDOR mentioned that radio, television, and other channels used by the government to communicate their initiatives are not highly effective because everyone does not have access to these channels of communication. Underscoring this point, 70 percent of respondents to the parent and caregiver survey were unaware of government benefits that support households with children with disabilities or their educational participation. Lack of awareness was the main barrier (90 percent) to accessing any government benefits that could support the needs of children with disabilities. When asked what social protection programs are available to support the education of children with disabilities in Rwanda, NCPD representatives were not able to point to any that provide such support. Table 3.4: Top Three Barriers to Accessing Benefit Schemes (Rwanda) (%) BARRIERS TO ACCESSING BENEFIT SCHEMES DISTRICTS TOTAL(N=271) KIGALI RUBAVU HUYE Lack of awareness/knowledge about the scheme 90 90 93 87 Lack of personal assistant to accompany me to the 15 39 1 2 pick-up office/place Behavior of the program officials towards me 7 5 2 14 The government facilitates the children with disabilities by providing medical care, paying school fees for some poor families, and providing assistive devices. There are categories based on what a family gains financially and if the family is poor the government helps them. Also, the parents of children with disabilities have associations and they are being supported in those associations. (MINEDUC) PARENTAL ATTITUDES, PERCEPTIONS, & EXPERIENCES OF DISABILITY-INCLUSIVE EDUCATION The significant majority (94 percent) of parents and caregivers agreed that children with disabilities have a right to education irrespective of their type of disabilities and location. Participants also had high aspirations for their children’s educational outcomes. Eighty-five percent hoped their child would continue their education beyond high school and believed that a university education was important for their child’s future. The finding contradicts the literature showing that parents of children with disabilities are more likely to have lower aspirations and expectations of their children’s educational outcomes (e.g., Banks et al., 2016; Chartztheochari, 2018). Among parents and caregivers of girls with disabilities, 50 percent agreed and 32 percent strongly agreed with the importance of a university education; for boys, 35 percent agreed and 58 percent strongly agreed with the importance of a university education for their children. However, 59 percent also agreed that their expectations for their child’s education had changed because of their child’s disability. Sixty-eight percent of the respondents stated that their children with disabilities aspired to higher educational attainment, with 52 percent saying that their children wanted to complete university 42 | UNDERSTANDING MULTIDIMENSIONAL DETERMINANTS OF DISABILITY-INCLUSIVE EDUCATION: or college level education (54 percent for boys with disabilities and 51 percent for girls with disabilities). The findings of parents believing that their child has a right to education and hoping that their child would continue their education beyond high school were not entirely reflected in the stakeholder interviews. There were references to parents not believing their child could transition to higher levels of education. School administrators mentioned parents only dropping their children with disabilities off but not visiting as often as advisable. Other stakeholders feel that parents’ negative beliefs and perceptions impact children’s participation in inclusive education in Rwanda. “First of all, we have to educate the parents and the community because some of the parents think that there is no use in educating a disabled child.” (MINEDUC) “[Parent involvement] changes their negativity” (itinerant teacher) Figure 3.6: Aspirations and Expectations for their Child’s Education (Rwanda) (%) 100 PERCENTAGE OF RESPONDENTS 90 80 70 59 60 86 83 89 50 40 9 30 20 32 10 7 8 7 7 7 4 0 I hope my child My child is aware My expectations I believe that will continues of my ideal for my child’s a university his/her education educational dreams education have education is after high school for him/her changed because of important for my his or her disability child’s future ASPIRATIONS AND EXPECTATIONS Disagree Neither agree Agree Note: n=271 Overall, only 30 percent of the caregivers in Rwanda expressed confidence in their ability to ensure that their child’s school will meet their educational needs. Parents and caregivers of children with difficulties in self- care, concentrating, and controlling behavior recorded the lowest confidence, at 13 percent, 10 percent, and 10 percent, respectively. Respondents with children in special schools were most confident of their ability to ensure that the school would meet their child’s needs (50 percent), followed by children in regular schools (30 percent). LESSONS FROM RWANDA, SIERRA LEONE, AND ZAMBIA | 43 Evidence in the field of inclusive education shows that special schools, often segregated by type of disability, often continue to receive more targeted resources and expertise to support children with disabilities than regular schools. This continues to create a discrepancy between the goal to educate children with and without disabilities in the same schools and the realistic supports, accommodations, and services children with disabilities tend to receive in special schools. As observed in the World Bank’s Landscape Review of Disability-Inclusive Education, special schools are also more likely to be staffed with teachers trained to work with children with disabilities. The integrated school model was the least cited. Figure 3.7: Confidence in Ability to Ensure School Meets Child’s Needs by Type of School (Rwanda) (%) 60 60 PERCENTAGE OF RESPONDENTS 50 40 40 33 33 30 26 22 20 20 17 17 13 10 8 7 5 0 0 0 Not confident at all Slightly confident Somewhat confident Quite confident Extremely confident LEVEL OF CONFIDENCE Regular school Special school Integrated school Note: n=138 Forty-four percent of respondents helped with their child’s schoolwork on a weekly basis or more often, 8 percent helped monthly, and 28 percent responded that they were never involved with their child’s schoolwork. Twenty-eight percent of respondents visited their child’s school weekly or more often, 18 percent visited monthly, and 38 percent visited once or twice a term. Mothers were most involved among the different caregiver groups, representing 64 percent of caregivers who helped with homework weekly or more often, and 63 percent of caregivers who visited schools weekly or more often. Respondents also identified specific actions that would help them be more involved in their child’s education, as listed in table 3.5. 44 | UNDERSTANDING MULTIDIMENSIONAL DETERMINANTS OF DISABILITY-INCLUSIVE EDUCATION: Table 3.5: Recommended Actions to Increase Parent/Caregiver Involvement in Education (Rwanda) (%) ACTIONS TO INCREASE PARENT/CAREGIVER INVOLVEMENT IN EDUCATION PERCENT Assign homework that requires my child to talk with me about things learned in class 50 Contact me if my child is having problems in school or in class 48 Invite me personally to programs at the school 45 Involved in development of Individualized Education Plan 41 Parent visitation days to the school 36 Send home clear notices that I can read easily 20 A smaller subset of respondents (76) answered questions on whether they felt their children’s teachers understand and support their child’s needs. Respondents with children with difficulties in seeing (91 percent), walking (80 percent), and communications (83 percent) responded more affirmatively than the other domains. Respondents with children with difficulties in the domains of hearing (67 percent), accepting change (67 percent), concentrating, and remembering (69 percent) responded less positively regarding teachers’ understanding and support for their child’s needs. Responses were also lower for teachers of children showing signs of anxiety (62 percent) and depression (63 percent). Parents and caregivers felt that their children were well included in mainstream academic activities, such as lessons, tests, and examinations (90 percent). Children with difficulties in communication (74 percent), concentrating (73 percent), and making friends (72 percent) felt less included in schoolwork compared to the sample aggregate. Children remained well included during meals (80 percent), and close to three-fourths (74 percent) participated in recess or playtime at school. Involvement and participation rates drop for extracurricular activities, including sports (66 percent), club activities (51 percent), educational tours and field visits (51 percent), and arts such as music, dance, and drama (49 percent). The decline in inclusion in extracurricular activities varies among the different domains of functioning difficulties. For example, only about one third of children with difficulties in walking and self-care felt included in clubs and educational field visits. Children with intellectual and learning disabilities also show significant drops in participation in extracurricular activities (table 3.6). The survey also asked about community engagement for the children, and 66 percent of respondents said their children have friends in the community. LESSONS FROM RWANDA, SIERRA LEONE, AND ZAMBIA | 45 Table 3.6: Inclusion in School Activities by Domain of functional difficulty (Rwanda) (%) MEALS (if available) MUSIC, DANCE, AND PLAYTIME/RECESS DRAMA FESTIVALS CLUB ACTIVITIES (lessons, tests, examinations) EDUCATIONAL CLASSROOMS TOURS/FIELD MAINSTREAM DOMAIN OF FUNCTIONAL DIFFICULTY SPORTS VISITS TOTAL (N=138) 90 80 74 66 51 51 49 SEEING 83 83 79 79 58 71 67 HEARING 78 67 67 72 50 50 28 WALKING 87 77 60 43 32 32 34 SELF-CARE 82 85 64 56 33 33 44 COMMUNICATION 74 80 63 63 46 54 43 LEARNING 81 77 66 62 34 45 34 REMEMBERING 79 81 65 60 33 35 37 CONCENTRATING 73 80 60 43 33 33 33 ACCEPTING CHANGE 77 77 69 57 37 43 37 CONTROLLING BEHAVIOR 77 77 71 58 23 35 39 MAKING FRIENDS 72 78 61 61 39 44 44 ANXIETY 85 77 62 58 46 42 31 DEPRESSION 100 82 71 53 59 47 35 The survey asked respondents about their perceptions of the availability of community support and attitudes toward children with disabilities. Sixty-one percent believed that their community was not supportive of families with children with disabilities. Many thought that the government is responsible for supporting children with disabilities. Forty-seven percent of those who said the community was not supportive believed this because they do not receive direct support from community members, and 24 percent specified that the community does not care about persons with disabilities or realize that children with disabilities have rights. However, three-fourths (75 percent) also stated that their community believes that children with disabilities should be in school and believe that they are capable of doing anything. Eighty-three percent said that they do not receive help from community members to support their children’s educational needs. The majority (81 percent) were not aware of support groups at their child’s school for parents of children with disabilities, and 72 percent said they did not have informational resources available. Only one fifth (20 percent) said they had access to training, workshops, or informational meetings on children with disabilities. Almost none of the parents had contact lists for service providers. “Community attitudes [are a barrier to implementing inclusive education in Rwanda] because some think that those children are not allowed to go to school.” (MINEDUC) “Rwanda has every high awareness that disabled people are part of people who will develop the country and the citizens are prone to good understanding.” (School Admin, School for the Deaf) 46 | UNDERSTANDING MULTIDIMENSIONAL DETERMINANTS OF DISABILITY-INCLUSIVE EDUCATION: LESSONS FROM RWANDA, SIERRA LEONE, AND ZAMBIA | 47 Source: Deepti Samant Raja, World Bank. 4 48 | UNDERSTANDING MULTIDIMENSIONAL DETERMINANTS OF DISABILITY-INCLUSIVE EDUCATION: Source: Deepti Samant Raja, World Bank. 4 4. COUNTRY CASE STUDY: SIERRA LEONE BACKGROUND Sierra Leone launched its Universal Primary Education program in 1993 (Nishimuko, 2014) and a Free Quality School Education (FQSE) program that provides free admission and tuition to all children in government schools in 2018. Sierra Leone signed the Convention on the Rights of Persons with Disabilities (CRPD) and its Optional Protocol on March 30, 2007, and ratified the CRPD on October 4, 2010. The Government of Sierra Leone has enacted both mainstream and specific disability legislation that are discussed in this section. The Constitution of Sierra Leone 1991, amended in 2008 and 2016, mandates that government should ensure equal rights and adequate educational opportunities for all citizens at all levels. It places special emphasis on the protection and promotion of the rights of vulnerable groups, including persons with disabilities. The Education Act 2004 forbids discrimination in the admission and treatment of basic education, including on the grounds of disability. Additionally, the Education Act establishes and mandates that the National Commission for Basic Education should protect the right to basic education for all citizens, with an emphasis on amputees. This focus stems from the higher rate of physical disabilities in the country and a possible causal role of the civil war in the prevalence of amputation or other physical disabilities. The Child Rights Act 2007 contains a disability-specific provision on the education of children with disabilities and stipulates remedies for its violation. Article 30 states that a child with disabilities has a right to specialized care, education, and training wherever possible to develop his maximum potential and be self-reliant. The Persons with Disability Act 2011 provides a comprehensive legal framework for the protection of the rights of persons with disabilities in many domains, including education. It not only obligates the government to ensure access to educational institutions for persons with disabilities and prohibits the denial of admission solely based on their disability, but it also requires educational institutions to consider the learners’ educational needs in terms of accessible school infrastructure and pedagogical inclusion. The government demonstrates a commitment to the education of persons with disabilities by designating a funding mechanism and mandating a scholarship incentive for teachers who train in inclusive education. In 2021, Sierra Leone enacted an ambitious, progressive, and radical education policy called the National Policy on Radical Inclusion in Schools (Ministry of Basic and Senior Secondary Education, 2021). The policy adopts UNESCO’s definition of inclusion, which broadly frames it as “a process of addressing and responding to the diversity of needs of all learners through increasing the participation in learning, cultures, and community, and reducing the exclusion within and from education” and places the responsibility to educate all children on the regular education system. This policy is based on the recognition of the fact that exclusion in education can be intentional or unintentional, arising from the action or inaction of individuals, society, or institutions at various levels. This “radical” inclusion aims to remove all dimensions or sources of exclusion intentionally and with urgency. It is a way of increasing justice and equity in the school system within an enabling and inclusive environment. The sections below present findings of the case study involving 162 parents and caregivers of children with disabilities and 25 key informants. Of the responding parents and caregivers, 61 percent were female and 39 percent, male. Thirty-five percent of the respondents were mothers of the child with disabilities, 15 percent were fathers, 41 percent were other family members, such as siblings, grandparents, aunts or uncles. Ten percent were external caregivers. LESSONS FROM RWANDA, SIERRA LEONE, AND ZAMBIA | 49 TYPE OF DISABILITY According to the Annual School Census Report of 2019, the dominant type of disability is physical disabilities (21.8 percent) (Statistics Sierra Leone, 2015). In the present study, children with functional difficulties in walking represented 41 percent of all children with functional difficulties in the sample, followed by children with functional difficulties in self-care (30 percent), and communicating (29 percent). Twenty-seven percent of children showed signs of anxiety and depression each. The finding is similar to that of a Multiple Indicator Cluster Survey (MICS) conducted by UNICEF, which reported that 13 percent of the children manifested signs of severe anxiety, while 9 percent were very sad or depressed on a daily basis (UNICEF, 2019). Figure 4.1: Children with Functional Difficulties (Sierra Leone) (%) PERCENTAGE OF CHILDREN WITH DIFFERENT 50 41 40 30 29 FUNCTIONAL DIFFICULTIES 30 27 27 21 24 23 20 19 17 17 12 12 10 0 Seeing Hearing Walking Self-care Communicating Learning Remembering Concentrating Accepting change Controlling behavior Making friends Signs of anxiety Signs of depression TYPES OF FUNCTIONAL DIFFICULTIES Note: n=138 SCREENING AND ASSESSMENT Almost half the children in Sierra Leone had acquired their disability at birth (49 percent), while 41 percent acquired their disability after birth but before starting school, and 9 percent had acquired it after starting school. Only 56 percent of parents and caregivers responded that their child had been screened or assessed for a disability or functional difficulty. Most children with disabilities (74 percent) were screened or assessed at a hospital, compared with being assessed at home by a community health worker (7 percent) or at school (7 percent). The school administrators interviewed indicated that they had little to no tools available to screen or assess the students and often referred them to local hospitals for screening. One school administrator indicated that they tend to rely on visible physical features to make their decisions. “No tools for screening so we always have to refer to the hospital” (School Administrator, Special School) 50 | UNDERSTANDING MULTIDIMENSIONAL DETERMINANTS OF DISABILITY-INCLUSIVE EDUCATION: Most of the children (53 percent) received a one-time assessment, while 34 percent had received periodic assessment, which had been completed at the time of the survey, and 14 percent were receiving ongoing periodic assessments. Only 33 percent of the children receive regular check-ups for their functional difficulties, and 83 percent receive check-ups at a hospital. These responses seem to indicate that most of the screenings and assessments are medical in nature and may not be assessing the learning or educational needs of children with disabilities. SCHOOL ATTENDANCE, ENROLLMENT, AND RETENTION OUT-OF-SCHOOL CHILDREN Most parents and caregivers in the sample (96 percent) confirmed that their children had enrolled in formal primary school (n=155), and of these, 91 percent were still enrolled in school at the time of the survey. A higher percentage of children who had enrolled in school were boys (53 percent) than girls (47 percent). This gender difference was also reflected among children enrolled in school at the time of the survey, with 57 percent being boys versus only 43 percent girls. For the small number of children who were not enrolled in school at the time of the survey (n=21), respondents listed the unaffordability of the additional costs to support their children’s disability-related needs (48 percent) and not receiving admission on account of disability (29 percent) as the main reasons. It should be noted that data from the Sierra Leone Population and Housing Census (United Nations Population Fund Sierra Leone, 2017) shows a higher out-of-school rate (63 percent) among children aged 3 and older. TYPE OF SCHOOL The following findings focus on children with disabilities who were attending school (n=141). Most of the children went to public day schools (60 percent), followed by public boarding schools (16 percent), public boarding schools as a day student (11 percent), and private day schools (11 percent). These numbers differed when compared across urban (n=120) and rural areas (n=20). Among the smaller number of children in rural areas, 75 percent were in public boarding schools, 15 percent in boarding schools as day students, and 10 percent in private day schools. Children in urban areas mostly went to public day schools (51 percent), followed by private day schools (11 percent), public boarding schools as day students (11 percent), and public boarding schools (6 percent). Figure 4.2: Type of School Attended (Sierra Leone) (%) 100 100 90 85 PERCENTAGE OF CHILDREN 80 70 67 70 60 50 40 28 31 30 15 20 10 2 3 0 0 0 0 Total Urban Peri-urban Rural TYPE OF SCHOOL Regular school Special school Integrated school Note: n=141 LESSONS FROM RWANDA, SIERRA LEONE, AND ZAMBIA | 51 Although special schools were not explicitly referenced in the Sierra Leone’s education laws and policies, they exist in practice. Of the children currently attending school, 70 percent attended regular schools where children with disabilities study with children without disabilities in the same class, 28 percent were in special schools, and only 2 percent were in integrated schools where there was a separate classroom for children with disabilities. Children with functional difficulties in hearing were over 1.5 times more likely to be in special schools (62 percent), compared to regular schools (38 percent). Among children with difficulties in communication, 48 percent were in special schools, compared to 53 percent in regular schools. Girls had lower representation than boys in regular schools (31 percent vs. 45 percent, respectively). Among parents and caregivers whose children went to regular schools, 66 percent were aware of other children with disabilities at the school, 25 percent were not, and 8 percent were not sure. Only 10 percent said their child attended a school that had an inclusive education resource center to provide learning materials and support for students with disabilities. SCHOOL ENROLLMENT AND RETENTION The Sierra Leone sample showed an overall school retention rate of 91 percent. Children with functional difficulties in hearing and cognition and those showing signs of anxiety had lower-than-average retention rates. This reflects findings from a recent UNICEF (2019) study that showed there is little difference in enrollment of children with and without disabilities, but significant differences within various categories of disabilities, with those with difficulty hearing and seeing having lowest school attendance. Bo had a high retention rate of 98 percent, followed by Freetown (88 percent), and Kenema (87 percent). (Currently enrolled) Retention rate = x 100% (Ever enrolled) Figure 4.3: School Retention Rates (Sierra Leone) (%) 100 94 94 93 98 91 92 91 89 89 89 90 87 88 88 86 85 88 87 80 70 60 PERCENTAGE OF CHILDREN 50 40 30 20 10 0 Learning Remembering Controlling behavior Making friends Signs of anxiety Signs of depression Free Town Communicating Self-care Concentrating Bo Total Seeing Hearing Walking Accepting change Kenema DOMAIN OF FUNCTIONAL DIFFICULTIES DISTRICTS Note: n=155 52 | UNDERSTANDING MULTIDIMENSIONAL DETERMINANTS OF DISABILITY-INCLUSIVE EDUCATION: Close to half the parents and caregivers of children in school (47 percent) stated that their child had to repeat a grade at some point. More boys (50 percent) had repeated a grade than girls (44 percent); however, 17 percent of girls had to stop their education at some point, compared to 8 percent of boys. Medical reasons were the major cause for repetitions (61 percent) in the sample, followed by not receiving passing marks in core subjects (21 percent) and financial constraints preventing completion of the previous academic year (20 percent). One- fourth of children (25 percent) had interrupted their education for an extended duration at some point during their school years. Parents and caregivers cited medical reasons (46 percent), financial constraints due to costs associated with learning materials or to support disability-related needs (43 percent), and a lack of accessible transportation to school (34 percent) as the factors behind the decision. ACCESS TO ASSISTIVE DEVICES, LEARNING MATERIALS, AND OTHER ACCOMMODATIONS ASSISTIVE DEVICES Across the total sample for the Sierra Leone case study (n=167), only 23 percent of children with disabilities used assistive devices. However, 85 percent of the parents and caregivers of children who did not currently use assistive devices said that their children would benefit from the use of an assistive device, signaling a significant gap between demand and supply (see figure 4.4). Children with functional difficulties in the domains of concentrating (0 percent), hearing (7 percent), communication (11 percent), and learning (11 percent) showed the lease usage of assistive devices. In terms of districts, children in Freetown used assistive devices the least (13 percent), compared with Kenema (33 percent) and Bo (29 percent). Figure 4.4: Gap between Use of and Need for Assistive Devices (Sierra Leone) (%) 100 100 91 93 92 95 94 94 90 90 90 86 80 75 77 70 67 60 PERCENTAGE OF CHILDREN 50 40 36 30 24 29 25 23 20 11 15 11 13 16 10 7 9 0 0 Signs of depression Seeing Hearing Walking Self-care Communicating Learning Remembering Concentrating Accepting change Controlling behavior Making friends Signs of anxiety DOMAIN OF FUNCTIONAL DIFFICULTIES Does your child currently use any assistive device? If not, would your child benefite from the use of an assistive device? Note: n=162 for question on current use of assistive device; n=124 for question on potential benefit from assistive device LESSONS FROM RWANDA, SIERRA LEONE, AND ZAMBIA | 53 The largest gaps were observed for families of children with functional difficulties in hearing and concentrating. Having access to assistive devices, such as hearing aids, may be essential to the educational participation of children with hearing disabilities. Children with functional difficulties in walking and self-care had the highest rates of use, at 34 percent and 29 percent respectively. Mobility aids and devices were the largest category of assistive devices in use, with 34 percent using wheelchairs or scooters, 29 percent using crutches, and 21 percent using canes/walking sticks. Although the Persons with Disabilities Act 2011 (Article 31 (1)) permits using part of the National Fund for Persons with Disabilities to procure assistive devices, most of the assistive devices are provided by NGOs. Forty-seven percent of the respondents whose children are using assistive devices (n=38) obtained them from NGOs and CBR centers. Among the rest, 24 percent received their devices through family and friends; 24 percent received them from the public sector including government facilities, public hospitals, and public schools; and 13 percent received them from the private sector. When asked about payment, 53 percent reported that the NGO sector paid for their devices, 37 percent paid for their devices out of pocket, and 13 percent received support from the government. School administrators who were interviewed noted that the available assistive devices were not adequate for the number of students who needed them, and one mentioned not having any at all despite having students with disabilities in the school. Most of these devices are provided by NGOs. Most parents and caregivers (47 percent) selected the devices used by their children on the recommendation of a specialist, such as an assistive technology specialist, health provider, physiotherapist, or speech language pathologist. Others learned about them from other parents of children with disabilities (21 percent), received recommendations from their teachers (21 percent), or picked the only device available to them (21 percent). Among the children using assistive devices, 76 percent could not access them at school. Parents and caregivers of children who cannot access assistive devices in school cited a lack of awareness/knowledge about the appropriate assistive devices (48 percent) as the main barrier. PERSONAL CARE ASSISTANCE Children with disabilities have a significantly higher need of personal assistance at home than in school. Forty-three percent of the children with disabilities in the sample had someone assisting them with day- to-day activities at home; this number dropped to 30 percent for those with assistance at home and school. Parents and caregivers whose children need assistance but do not receive it listed the high cost of personal assistants (62 percent), followed by a lack of information about where to get them (35 percent), and a lack of awareness and about personal assistants (27 percent) as the main reasons for the unmet need. See table 4.1 for disaggregation by type of functional difficulty. 54 | UNDERSTANDING MULTIDIMENSIONAL DETERMINANTS OF DISABILITY-INCLUSIVE EDUCATION: Table 4.1: Personal Care Assistance in Day-to-Day Activities (Sierra Leone) (%) At At At NO – NO – home school home does not but DOMAIN OF FUNCTIONAL DIFFICULTY only only and need needs school SEEING 32 11 32 16 8 HEARING 47 17 10 17 10 WALKING 38 11 35 15 2 SELF-CARE 46 8 29 13 4 COMMUNICATION 40 13 23 13 11 LEARNING 47 18 26 3 6 REMEMBERING 50 14 18 11 7 CONCENTRATING 55 25 15 0 5 ACCEPTING CHANGE 50 11 21 14 4 CONTROLLING BEHAVIOR 45 16 18 16 5 MAKING FRIENDS 37 11 32 11 11 ANXIETY 53 5 14 21 7 DEPRESSION 37 5 40 12 7 Of the children who have personal care assistance only at home, 70 percent are in regular schools, while 24 percent are in special schools, and 3 percent are in integrated schools. Among children who receive such assistance at school only, 73 percent are in special schools, while 27 percent are in regular schools. LESSONS FROM RWANDA, SIERRA LEONE, AND ZAMBIA | 55 ACCOMMODATIONS FOR LEARNING NEEDS The Persons with Disabilities Act 2011 and the National Policy on Radical Inclusion in Schools contain strong provisions requiring accommodations in both pedagogical practices and infrastructure. However, among the cohort attending school (n=141), 77 percent of the respondents stated that their child had not received any accommodations or modifications for their learning needs in school despite needing accommodations. Only 15 percent in the study sample had received learning-related modifications, while 9 percent stated that their children did not need accommodations for learning needs. Unmet needs for learning accommodations were highest in children with difficulties in the domains of accepting change (78 percent), communication (75 percent), hearing (73 percent), and learning (73 percent). Children showing signs of anxiety (77 percent) and signs of depression (79 percent) also had high rates of not receiving accommodations for their learning needs. Issues of accessibility, accommodation or other modifications have been researched. Although accessibility is a legal requirement, the 2019 Annual School Census revealed that only 10 percent of the 11,168 schools in the country had ramps. Figure 4.5:  Children with Functional Difficulties Lacking Accommodations/Modifications for Learning Needs (Sierra Leone) (%) 80 78 79 75 77 73 73 71 71 71 70 69 69 61 60 59 PERCENTAGE OF CHILDREN WITH DIFFERENT 50 40 FUNCTIONAL DIFFICULTIES 30 20 10 0 Seeing Hearing Walking Self-care Communicating Learning Remembering Concentrating Accepting change Controlling behavior Making friends Signs of anxiety Signs of depression TYPES OF FUNCTIONAL DIFFICULTIES Note: n=162 Children across different types of schools had high unmet needs for learning accommodations and modifications. Children who had received accommodations for learning needs were more likely to be in special schools (62 percent), compared to regular schools (33 percent). However, high proportions of children with disabilities reflected unmet needs for accommodations in both regular (82 percent) and special schools (65 percent). “For now, we don’t have any learning equipment to facilitate the learning process for children with disabilities.” School Admin, regular school 56 | UNDERSTANDING MULTIDIMENSIONAL DETERMINANTS OF DISABILITY-INCLUSIVE EDUCATION: Figure 4.6:  Children Receiving Accommodations/Modifications for Learning Needs, by Regular or Special School (Sierra Leone) (%) 90 82 80 PERCENTAGE OF CHILDREN 70 65 60 50 40 33 30 20 11 10 7 3 0 Yes Need but do not receive Do not receive RECEIVING ACCOMMODATIONS/MODIFICATIONS FOR LEARNING NEEDS Regular school Special school Note: n=162 Among the small sample of children receiving learning accommodations (n=21), the accommodations included materials in Braille (57 percent), personal aides (33 percent), materials in large print (19 percent), sign language interpretation (14 percent), and adapted seating arrangements (14 percent). The survey enquired if children with disabilities also had access to reading and learning materials at home. This is important to ensure their continuity of learning and access to materials at home like their peers without disabilities. Three-fourths of the participants (76 percent) said their children did not have access to books at home in a format they can read, and 70 percent said their children did not have access to learning materials in preferred formats. A little over half (55 percent) said their children were able to complete homework or study for examinations at home, while 45 percent said they were not able to do so. The majority of the respondents (79 percent) said their child had access to toilets and other water and sanitation facilities at school. These numbers declined for children with functional difficulties in walking (67 percent) and children with signs of depression (55 percent). Only 42 percent stated their children received the support they needed with accessing water and sanitation facilities in school. ADDITIONAL EXPENSES FOR FAMILIES The survey asked respondents about the overall additional costs they incur to support the educational participation of their children with disabilities that they would not face for a child without disabilities. The highest additional out-of-pocket expenses were for transportation costs for adapted or accessible vehicles (45 percent), followed by hiring personal assistants (38 percent), adapted learning materials (32 percent), and assistive devices (26 percent). The findings confirm the available literature that says indirect costs such as transportation, exams, tuition, uniforms, and textbook fees illicitly levied by schools pose a significant burden for many parents (Nishimuko, 2014). Children with disabilities incur extra costs for accessible transportation to school, assistive devices, as well as teaching and learning aids, such as recording equipment and Braille materials. Figure 4.7 breaks down the costs by domain of functional difficulty. Parents and caregivers of children with functional difficulties in hearing (72 percent), communication (54 percent), and concentration (50 percent) bore the highest additional costs of transportation. LESSONS FROM RWANDA, SIERRA LEONE, AND ZAMBIA | 57 Figure 4.7:  Additional Costs by Domain of Functional Difficulty (Sierra Leone) (%) PERCENTAGE OF RESPONDENTS 0 20 40 60 80 Seeing Hearing Walking Self-care Additional transport Communicating DOMAIN OF FUNCTIONAL DIFFICULTY costs related to adapted/accessible vehicles Learning Hiring cost of personal assistant Remembering Out of pocket costs of assistive technology/ device(s) Concentrating Added costs of adapted learning materials Accepting change Controlling behaviour Making friends Signs of anxiety Signs of depression Note: n=141 58 | UNDERSTANDING MULTIDIMENSIONAL DETERMINANTS OF DISABILITY-INCLUSIVE EDUCATION: TRANSPORTATION TO SCHOOL AND COMMUNITY INFRASTRUCTURE Thirty-six percent of respondents stated that buildings in their community were accessible for persons with disabilities. Only 15 percent stated that transportation in their community was accessible, and 24 percent stated that rehabilitation resources and services were available in their communities (see table 4.2). Table 4.2: Perceptions of Community Accessibility (Sierra Leone) (%) COMMUNITY ACCESS FEATURES DISTRICTS TOTAL (N=162) FREETOWN BO KENEMA Yes 36 37 24 51 Are buildings in your community accessible for persons/children No 61 3 0 5 with disabilities? Don’t know 2 13 13 47 Yes 15 12 31 2 Is transportation accessible? No 85 88 69 98 Don’t know 0 - - - Yes 24 21 35 16 Are there rehabilitative resources and services available in your No 73 76 65 77 area? Don’t know 3 3 0 7 Most children (48 percent) travelled to school on foot, 33 percent used motorcycles, 14 percent used taxis, and 11 percent used public or private buses not provided by the school. Half the respondents (50 percent) have additional out-of-pocket expenses for accessible transportation to school. These figures vary by domain of functional difficulty, with most additional expenses incurred by parents and caregivers of children with difficulties in the domains of accepting change (65 percent), controlling behavior (63 percent), hearing (62 percent), and seeing (59 percent). ACCESS TO SOCIAL BENEFITS AND SCHEMES TO SUPPORT INCLUSIVE EDUCATION Eighty-five percent of the respondents were unaware of any government benefits that support households with children with disabilities or their educational participation, and 6 percent were not sure. Only 7 percent stated that there were scholarships available for their children with disabilities to attend school. Lack of awareness was the main barrier (64 percent) to accessing any government benefits that could support the needs of children with disabilities, followed by perceptions of insufficient monetary value of benefits (18 percent), and extra expenses incurred in the process of getting the benefits (13 percent). Parents and caregivers who are receiving government benefits to support their children with disabilities cited costs for transportation (40 percent) and hiring personal assistants (40 percent) as additional out-of-pocket expenses incurred as a result of efforts to access the benefits. LESSONS FROM RWANDA, SIERRA LEONE, AND ZAMBIA | 59 Table 4.3: Top Three Barriers to Accessing Benefit Schemes (Sierra Leone) (%) BARRIERS TO ACCESSING BENEFIT SCHEMES DISTRICTS TOTAL FREETOWN BO KENEMA (N=162) Lack of awareness/knowledge about the scheme 64 68 39 88 Insufficient benefits amount 18 13 31 9 Extra expenses incurred in the process of getting 13 9 25 5 the benefits PARENTAL ATTITUDES, PERCEPTIONS, AND EXPERIENCES OF DISABILITY-INCLUSIVE EDUCATION Overall, almost all the caregivers affirmed that children with disabilities have a right to education. Participants also had high aspirations for their children’s educational outcomes. Ninety percent hoped that their child would continue their education beyond high school, and 93 percent believed that a university education was important for their child’s future. However, 59 percent felt that their expectations for their child’s education had changed because of their child’s disability. The majority of the respondents (92 percent) stated that their children with disabilities aspired to higher educational attainment, with 77 percent saying that their children wanted to complete university or college level education, and 16 percent listing tertiary institutions. Figure 4.8: Aspirations and Expectations for Child’s Education (Sierra Leone) (%) 100 PERCENTAGE OF RESPONDENTS 90 80 70 59 60 90 96 50 93 40 10 30 20 30 10 2 8 13 15 0 I hope my child My child is aware My expectations I believe that will continues of my ideal for my child’s a university his/her education educational dreams education have education is after high school for him/her changed because of important for my his or her disability child’s future ASPIRATIONS AND EXPECTATIONS Disagree Neither agree Agree 60 | UNDERSTANDING MULTIDIMENSIONAL DETERMINANTS OF DISABILITY-INCLUSIVE EDUCATION: Among the participants who provided data on the sex of their child with disabilities (n=42), there were some differences between responses for girls and boys. Sixty-three percent of parents and caregivers of boys with disabilities strongly agreed with the importance of a university education for their child, compared with 44 percent of parents and caregivers of girls with disabilities. Fifty-eight percent of parents and caregivers of boys agreed and 42 percent strongly agreed with the hope that their child would continue their education after high school. In comparison, 28 percent of parents and caregivers of girls with disabilities agreed and a much higher 56 percent strongly agreed that their child should continue their education after high school. The survey enquired about parents’ and caregivers’ confidence in their ability to successfully advocate for their child’s school to meet their learning needs. Most parents (65 percent) were not confident in their ability to ensure that the child’s school would meet their needs; 32 percent were not confident at all, whereas 33 percent were slightly confident. Only 30 percent felt confident that they could ensure that their child’s school would meet their needs. Within the Sierra Leone sample, parents, and caregivers of children in special schools had slightly higher levels of confidence than those of children in regular schools. To this point, one school administrator from a school for blind children spoke of the steps taken not only to prepare the students to transition to secondary mainstream schools, but also to prepare the secondary mainstream schools for children with disabilities. “What we do before we send a child to any inclusive school, we go and talk with the head teacher and even the teachers for them to have the understanding that they are [receiving] a blind child in that particular school…so that at the end of the day, when the child goes to that school, they will not find it difficult.” (School Administrator, Special School) “We had an idea at one point in time to build a separate school for blind children, but we thought it is not fine for there only to be a blind school. We decided to debunk the negative perception of what people have. That’s why we decided to be inclusive for the blind children to be mixed with those who have sight.” (School Administrator) The lowest levels of confidence were exhibited by parents and caregivers of children with difficulties in the domains of accepting change (21 percent) and learning (23 percent) and children showing signs of depression (21 percent). Figure 4.9: Confidence in Ability to Ensure School Meets Child’s Needs, by Type of School (Sierra Leone) (%) 50 47.5 PERCENTAGE OF RESPONDENTS 40 34.7 30 27.6 22.5 20.0 20 16.3 13.3 10.0 10 8.2 0.0 0 Not confident at all Slightly confident Somewhat confident Quite confident Extremely confident LEVEL OF CONFIDENCE Regular school Special school LESSONS FROM RWANDA, SIERRA LEONE, AND ZAMBIA | 61 Parents and caregivers in the sample were quite involved in their children’s education. A majority (70 percent) helped with their child’s schoolwork on a weekly basis or more often, while 15 percent helped monthly. Different categories of caregivers had similar rates of involvement in children’s schoolwork. Sixty percent of respondents visited their child’s school weekly or more often, 28 percent visited monthly, and 11 percent visited once or twice a term. Mothers were the most frequent visitors to school, with 73 percent visiting weekly or more, followed by fathers (67 percent), other family members (51 percent), and external caregivers (47 percent). Respondents also identified specific actions that would help them be more involved in their child’s education, as listed in table 4.4. Table 4.4: Recommended Actions to Increase Parent/Caregiver Involvement in Education (Sierra Leone) (%) ACTIONS TO INCREASE PARENT/CAREGIVER INVOLVEMENT IN EDUCATION PERCENT Involved in development of Individualized Education Plan 44 Assign homework that requires my child to talk with me about things learned in class 50 Send home clear notices that I can read easily 19 Contact me if my child is having problems in school or in class 44 Invite me personally to programs at the school 48 Parent visitation days to the school 43 Parents and caregivers felt that their children were well included in mainstream academic activities, such as lessons, tests, and examinations (87 percent) and included in playtime/recess activities (83 percent). Children with difficulties in hearing (69 percent), making friends (69 percent), remembering (70 percent), and concentrating (71 percent), felt less included in schoolwork, compared to the sample aggregate. Perceptions of inclusion dropped for non-academic activities at school, such as participation in extracurricular activities including sports (34 percent), club activities (6 percent), educational tours and visits (50 percent), and arts such as music, dance, and drama (42 percent) (table 4.5). The drops in inclusion in extracurricular activities are more prominent for different domains of functional difficulties. For example, children with difficulties in walking (21 percent) and self-care (22 percent) were least included in sports. Children with difficulties in remembering, controlling behaviors, and making friends had significant drops in participation in extracurricular activities. See table 4.5 for inclusion by domains of functioning difficulties. The survey also asked about community engagement for the children, and 86 percent of respondents said their children have friends in the community. 62 | UNDERSTANDING MULTIDIMENSIONAL DETERMINANTS OF DISABILITY-INCLUSIVE EDUCATION: Table 4.5: Inclusion in School Activities by Domain of functional difficulty (Sierra Leone) (%) PLAYTIME/RECESS CLUB ACTIVITIES MUSIC, DANCE, (lessons, tests, examinations) EDUCATIONAL CLASSROOMS TOURS/FIELD MAINSTREAM AND DRAMA DOMAIN OF FUNCTIONAL DIFFICULTY FESTIVALS available) MEALS (if SPORTS VISITS TOTAL (N=141) 87 83 65 34 6 50 42 SEEING 79 88 91 44 0 56 47 HEARING 69 92 85 58 8 65 46 WALKING 88 83 71 21 3 43 40 SELF-CARE 85 83 63 22 0 49 37 COMMUNICATION 75 90 73 60 8 70 35 LEARNING 73 80 70 57 3 57 33 REMEMBERING 70 83 74 48 0 39 35 CONCENTRATING 71 76 59 35 0 53 29 ACCEPTING CHANGE 83 87 74 26 4 57 43 CONTROLLING BEHAVIOR 88 91 66 34 3 41 31 MAKING FRIENDS 69 63 63 31 0 44 19 ANXIETY 91 86 51 37 0 54 40 DEPRESSION 84 82 66 24 0 32 37 The majority of respondents (61 percent) are happy with their child’s experience in their school. The survey asked respondents about their perceptions of availability of community support and attitudes toward children with disabilities. Most (93 percent) believed that their community was not supportive of families with children with disabilities. However, 66 percent also stated that their community believes that children with disabilities should be in school. Ninety-one percent said that they do not receive help from community members to support their children’s educational needs. Most (88 percent) respondents were not aware of any support groups for parents of children with disabilities in their community, and 72 percent said they did not have informational resources available. Less than 10 percent said they had access to training, workshops, or informational meetings on children with disabilities. Only 4 percent of the parents had contact lists for service providers, 10 percent had access to school rules and regulations, and 13 percent had school calendars. School administrators also suggested the need to engage in awareness-raising and sensitization activities for the wider community. “[We should] continue to engage and dialogue with them (community members) and inform them about how they should treat persons with disabilities.” (School Administrator, School for the Blind) We should sensitize the people on how things are going for children with disabilities” (School Administrator) LESSONS FROM RWANDA, SIERRA LEONE, AND ZAMBIA | 63 5 64 | UNDERSTANDING MULTIDIMENSIONAL DETERMINANTS OF DISABILITY-INCLUSIVE EDUCATION: Source: “Junior Onango in class.” Hamish Roberts, Leonard Cheshire Disability. 5 5. COUNTRY CASE STUDY: ZAMBIA BACKGROUND Zambia’s Constitution entrenches disability rights with a definition that aligned to the CRPD, ratified in February 2010. The National Disability Survey conducted in 2015 showed that 4.4 percent of children ages of 2 to 7 years have disabilities (Ministry of Community Development and Social Services, 2018). Based on the National Disability Survey, persons with disabilities had lower rates of education compared to persons without disabilities, and the level of education attained decreases with increasing severity of disability. Additionally, primary school was the highest level of education completed by 51 percent of persons with disabilities. Zambia’s Persons with Disabilities Act, 2012 recognizes both special schools and inclusive education. While the Act requires education to be inclusive at all levels, Article 23 (1) provides for special education. It designates public educational institutions to provide necessary facilities and equipment to enable persons with disabilities to fully benefit from public educational institutions. It also requires the government to establish special schools for children with disabilities, “who, by reason of their disability, cannot be enrolled in inclusive education institutions.” The Act prescribes a zero-rejection policy for admission to regular schools unless the Ministry responsible for Health assesses the person and determines they require a special school. The Education Policy, Educating Our Future 1996 (Republic of Zambia, Ministry of Education, 1996), reaffirms that every individual has an equal right to educational opportunities, but defines pupils with special educational needs with a medical model approach. The National Policy on Disability 2013 sets out a vision whereby persons with disabilities enjoy equal opportunities that are fundamental for living and development (Ministry of Community Development, Mother and Child Health, 2012). The National Disability Implementation Plan informs the government how policies and legislation that concern persons with disabilities could be used to ensure that their needs are mainstreamed. It aims to contribute to the overall process of participatory planning and development by government and non-state actors to improve the quality of life for persons with disabilities. The sections below present the findings of the case study involving 379 parents and caregivers of children with disabilities and 21 key informants. Of the responding parents and caregivers, 76 percent were female and 24 percent male. Sixty-two percent of the respondents were mothers of the child with disabilities, 17 percent were fathers, and 21 percent were other family members such as siblings, grandparents, aunts, or uncles. LESSONS FROM RWANDA, SIERRA LEONE, AND ZAMBIA | 65 TYPE OF DISABILITY Children with functional difficulties in walking represented 47 percent of all children with functional difficulties in the sample, followed by children with functional difficulties in self-care (36 percent), communicating (30 percent), and learning (20 percent). The representation of children with sensory, intellectual, and cognitive disabilities made up less than one fifth of the sample. Few children in the sample showed signs of anxiety (6 percent) and depression (5 percent). Figure 5.1: Children with Functional Difficulties (Zambia) (%) PERCENTAGE OF CHILDREN WITH DIFFERENT 50 47 40 36 30 FUNCTIONAL DIFFICULTIES 30 20 20 17 12 12 11 12 12 10 8 6 5 0 Seeing Hearing Walking Self-care Communicating Learning Remembering Concentrating Accepting change Controlling behavior Making friends Signs of anxiety Signs of depression Note: n = 379 TYPES OF FUNCTIONAL DIFFICULTIES SCREENING AND ASSESSMENT Like Rwanda and Sierra Leone, most children in Zambia acquired their disability at birth (59 percent), while 35 percent acquired their disability after birth but before starting school, and 6 percent acquired it after starting school. The survey asked parents and caregivers about screening and assessment facilities. Ninety-six percent of parents and caregivers responded that their child had been screened or assessed for a disability or functional difficulty. Almost all children (99 percent) were screened or assessed at a hospital, compared with being assessed at home by a community health worker or at school. Most of the children (43 percent) received a periodic assessment, which had been completed at the time of the survey; 41 percent were receiving ongoing periodic assessments; and 17 percent received a one-time assessment. Only 44 percent of the children receive regular check-ups for their functional difficulties, and 96 percent receive the check-ups at a hospital. These responses seem to indicate that most of the screenings and assessments are medical in nature and may not be assessing the learning or educational needs of children with disabilities. Several schools have partnerships with local hospitals and the University of Zambia (UNZA) to refer children for further assessment. Several schools require certification from the Ministry of Health as a criterion for admission, which can mean further follow-up assessment at the hospital or UNZA. “If there was an assessment center created so that we know whether our assumptions are correct or wrong…that would help” (School Admin, regular school) “You are just maybe speculating ‘this child has this’ and then maybe you call another person because within the school we have some people who have done the training on special education. They can tell whether it is true or not.” (School Administrator, regular school) 66 | UNDERSTANDING MULTIDIMENSIONAL DETERMINANTS OF DISABILITY-INCLUSIVE EDUCATION: SCHOOL ATTENDANCE, ENROLLMENT, AND RETENTION OUT-OF-SCHOOL CHILDREN Of the total sample of 379 respondents, only 212 (56 percent) stated that their children had ever attended formal primary school. Based on 128 participants reporting on the sex of their child with disabilities, 56 percent of the children who have ever attended school are boys and 44 percent are girls. Of all boys in the sample, 60 percent had attended school at some point, compared with 57 percent of the girls in the sample. The main barriers faced by parents and caregivers whose children with disabilities had never attended primary school were unaffordability of the additional costs to support their children’s disability-related needs (60 percent), high school fees or other costs (38 percent), long distances to school (29 percent), and a lack of accessible transportation to school (26 percent). The Ministry of Community Development mentioned that “there has been a deliberate move to go out into the field and sensitize the general public” about where to take children with disabilities to school. While there has not been much of an increase in the number of children with disabilities enrolling in school, “efforts are being made” to increase these numbers. “Some parents do not have the knowledge about where to take their kids with disabilities. There has been a deliberate move to go out into the field and sensitize the public” (Ministry of Community Development) Figure 5.2: Reasons Children were Never Enrolled in Primary School (Zambia) (%) PERCENTAGE OF RESPONDENTS 0 20 40 60 80 Perceived low benefit of education 12 REASONS FOR NOT ENROLLING IN PRIMARY SCHOOL Awaiting admission 8 No admission due to disability 10 Distance to school too far 10 Lack of accessible transportation 26 School fees or costs were too expensive 38 Unaffordable costs to support disability-related needs 60 School infrastructure not accessible 9 Child was receiving therapy/treatment services 10 Child was in informal educational setting 1 Other 2 No reason 1 Note: n = 379 LESSONS FROM RWANDA, SIERRA LEONE, AND ZAMBIA | 67 Table 5.1: Top Three Reasons for Absence from School by Domain of Functional Difficulty (Zambia) (%) SIGNS OF DEPRESSION CONTROLLING BEHAV- ACCEPTING CHANGE SIGNS OF ANXIETY COMMUNICATION MAKING FRIENDS CONCENTRATING REASONS FOR ABSENCE SELF-CARE LEARNING WALKING HEARING SEEING Could not afford additional costs to 67% 67% 64% 59% 51% 56% 50% 52% 62% 64% 44% 40% support disability- related needs School fees or costs 58% 47% 31% 31% 40% 36% 42% 41% 54% 55% 40% 30% were too expensive TYPE OF SCHOOL The following findings focus on the children with disabilities who attended school (n=120). The majority of children went to public day schools (61 percent), followed by private day schools (18 percent), and religious- sponsored day schools (13 percent). These numbers differed when compared across urban and peri-urban areas. A significant majority were enrolled in public day schools in peri-urban areas (92 percent), with the remainder in religious boarding schools (8 percent). Children in urban areas mostly went to public day schools (57 percent), followed by private day schools (21 percent), and religious sponsored day schools (14 percent). Figure 5.3: Type of School Attended (Zambia) (%) 80 69 60 59 PERCENTAGE OF CHILDREN 60 40 38 39 31 20 2 2 0 0 Total Urban Peri-urban TYPE OF SCHOOL Regular school Special school Integrated school Note: n=120 68 | UNDERSTANDING MULTIDIMENSIONAL DETERMINANTS OF DISABILITY-INCLUSIVE EDUCATION: Of the children currently attending school, 60 percent attended regular schools where children with disabilities study with children without disabilities in the same class, 38 percent were in segregated special schools, and only 2 percent were in integrated schools where there was a separate classroom for children with disabilities. Slightly over one third of the children (37 percent) attended a school that had an inclusive education resource center to provide learning materials and support for students with disabilities, while one third of the sample (33 percent) said they did not know if the child’s school had a resource center. A representative from the Ministry of Community Development aptly said “there are very few special schools, most of them are integrated schools. This is normally misunderstood to be inclusive education.” Additionally, an OPD representative stated that “we are still behind in achieving inclusive education as a country, as most policies only exist on paper” and “there is still a gap in implementing these policies.” SCHOOL ENROLLMENT AND RETENTION Of the 212 children who had enrolled in formal primary school at some point, only 57 percent were still enrolled in school at the time of the study, yielding a retention rate of 57 percent. It must be noted that data collection for the study took place during the COVID-19 pandemic, which may have also contributed to the higher enrollment losses in the Zambia study sample. Enrollment rates are higher for children with sensory and physical disabilities than for children with cognitive and intellectual disabilities. While this study did not focus on the impacts of the COVID-19 pandemic, it is important to note that the current enrollment rates were collected at a time of frequent school closures due to the pandemic. The rate of retention is calculated by calculating the percentage of currently enrolled students compared to those ever enrolled. As mentioned above, the Zambia sample showed an overall school retention rate of 57 percent. Children with functional difficulties in seeing (47 percent) and remembering (46 percent) and those showing signs of anxiety (38 percent) and depression (33 percent) had the lowest retention rates. Kaoma and Lusaka districts both had sharp drops, with retention rates of 48 percent each, whereas Kitwe had a high retention rate of 83 percent. (Currently enrolled) Retention rate = x 100% (Ever enrolled) Figure 5.4: School Retention Rates (Zambia) (%) 100 90 83 80 70 68 68 62 60 57 53 58 53 56 54 50 PERCENTAGE OF CHILDREN 50 47 46 48 48 40 38 33 30 20 10 0 Learning Remembering Controlling behavior Making friends Signs of anxiety Signs of depression Kitwe Communicating Self-care Concentrating Kaoma Total (n=212) Seeing Hearing Walking Accepting change Lusaka DOMAIN OF FUNCTIONAL DIFFICULTIES DISTRICTS Note: n=212 LESSONS FROM RWANDA, SIERRA LEONE, AND ZAMBIA | 69 Within a significantly smaller sample of 75 parents and caregivers whose children were in school at some point and who had provided the sex of their child, there was a sharper drop-off for girls than boys at the time of the study. Among the children still in school, only 29 percent were girls. Similarly, among girls who were enrolled in school at some point, 69 percent were not in school at the time of the study, compared with 41 percent of boys who were out of school. Only 15 percent of parents and caregivers of children in school (n=18) stated that their child had to ever repeat a grade. While this is a small number of children, the key reasons given for repetition were that financial constraints prevented completion of the previous academic year (39 percent), medical reasons (39 percent), and not receiving passing marks in core subjects. Less than one third of the sample (27 percent) stated their children needed to stop their education for an extended period. Most parents and caregivers of children who had to stop their education (56 percent) cited financial constraints due to costs associated with learning materials or to support disability-related needs, such as assistive devices, personal care assistants, transportation, as the major factors behind the decision to stop education. This was followed by medical reasons (39 percent) and the distance to school (13 percent). ACCESS TO ASSISTIVE DEVICES, LEARNING MATERIALS, AND OTHER ACCOMMODATIONS ASSISTIVE DEVICES Across the total sample for the Zambia case study (n=379), only 23 percent of children with disabilities used assistive devices. However, 80 percent of the parents and caregivers of children who did not currently use assistive devices said that their children would benefit from the use of an assistive device, signaling a significant gap between demand and supply (see figure 5.5). The Ministry of Education says that it is under the hospitals’ purview to assign assistive technology to the schools that have children with disabilities. Children with functional difficulties in the domains of hearing (6 percent), seeing (13 percent), communication (16 percent), learning (17 percent), and controlling behavior (17 percent) had the lowest use of assistive devices. In terms of districts, children in Kitwe (52 percent) had a higher use of assistive devices than those in Lusaka (37 percent) and Kaoma (12 percent). Figure 5.5: Gap between Use of and Need for 100% Assistive Devices (Zambia) (%) 91% 88% 86% 89% 90% 91% 81% 80% 79% 80% Percentage of respondents 88% 100 86% 91 89% 88% 80% 88 89 72% 81% 90 81 80% 86 80 79% 80% 70% 69% 70% 80 88 80 70% 72% 79 69% 70% 70% 70 70 72 70 60% 69 60 50% OF CHILDREN 50 40 3440% 34% 34% 30 30% 20 20% 18 23 22 23 23% 22% 23% 20 13 16 17 17% 17 18% 13 17% 15 20% 13% 16% 13% 1 10 20% 6 23% 22% 23% 17% 18% 6% 17% 13% 0 16% 10% 13% 15% PERCENTAGE 6% ak depression e Seeing n Hearing Walking gSelf-care ce Communicating e Learning Remembering Sig Concentrating m ty change Co s io behavior friends llin of anxiety 0% r ty g e g g r in ng g tin ng ion e s io r in nd ha lki n nx rni n ng tin ar xie ri ei av at f-c ri e ha be e n H ea tra Making Se ns Accepting a eh An a nic g B Se l W r gC g Le g g em gF g nc n ing ds en m io Controlling p in n ng tio ein gB ar of u Re e De n Signs ni Co ha v in in m alk ar i c ri e be es tra ica ar Signs of Se ns lf- pt He of W A gC pr Le em e gF Se Sig un ce M ro ns of De in in Ac m nc nt m Sig llin ns ak pt m Re Co Co of M Co ro Ac nt Domain of functional difficulty Sig Co DOMAIN OF FUNCTIONAL DIFFICULTIES Domain of functional difficulty Does your child current ly use any assistive devi ce? Does your Does child your current child ly useuse currently anyany assistive devi assistive ce? device? not, would If would If not, your your childchild benefite benefit from from the the use ofuse an of an assistive assistiv device? e device? If not, would your child benefit from the use of an assistiv e device? Note: n=379 for question on current use of assistive device; n=292 for question on potential benefit from assistive device 70 | UNDERSTANDING MULTIDIMENSIONAL DETERMINANTS OF DISABILITY-INCLUSIVE EDUCATION: The largest gap was observed for families of children with functional difficulties in hearing. Although 91 percent of families expressed a need for assistive devices, only 6 percent were using them. Having access to assistive devices such as hearing aids may be essential to the educational participation of some learners with hearing difficulties. Children with functional difficulties in walking had the highest rates of use, at 34 percent. Consequently, mobility aids and devices were the largest category of assistive devices in use, with 72 percent of children using wheelchairs or scooters and 9 percent using crutches. In Zambia, 60 percent of the respondents whose children are using assistive devices (n=87) indicated that the devices were obtained from the NGO sector, including nonprofit organizations and community-based rehabilitation centers. Among the rest, 24 percent received their devices from the public sector, including government facilities, public hospitals, and public schools; 9 percent received the devices from friends or family; and 7 percent responded that the devices were self-made. When asked about payment for the assistive devices, 61 percent reported that the NGO had paid for their devices, 20 percent said that they had paid for their devices out of pocket, and 18 percent received financing from the government. “Some [schools with assistive technology devices] are there but for some, especially for the physically disabled, their parent normally purchases or has something made for their child” (Ministry of Education) The majority of the parents and caregivers (86 percent) selected the devices used by their children on the recommendation of a specialist such as an assistive technology specialist, health provider, physiotherapist, or speech language pathologist. The rest (22 percent) learned about them from other parents of children with disabilities. Only 49 percent of children using assistive devices can access them at home and school. Fifty-two percent could access their device at school, and 53 percent could access it at home. Parents and caregivers of children who cannot access assistive devices in school cited lack of awareness/knowledge about the appropriate assistive devices (80 percent) as the main barrier, followed by language barriers (27 percent), the expense of the device (18 percent), devices being broken or requiring repair (16 percent), and not knowing where to obtain the devices (14 percent). “A large proportion [of assistive technology devices] are distributed into special schools, rather than regular schools. (OPD representative) PERSONAL CARE ASSISTANCE Children with disabilities have significantly higher rates of personal assistance at home than in school. Seventy- five percent of the children with disabilities in the sample (n=379) had someone assisting them with day-to-day activities at home, but this number dropped to 21 percent for those having assistance at home and school. Parents and caregivers listed the high cost of personal assistants (55 percent), followed by a lack of awareness about personal assistants (46 percent) and not knowing where to find or hire them (43 percent) as the main reasons for the unmet need. See table 5.2 for disaggregation by type of functional difficulty. LESSONS FROM RWANDA, SIERRA LEONE, AND ZAMBIA | 71 Table 5.2: Personal Care Assistance in Day-to-Day Activities (Zambia) (%) AT HOME ONLY AT HOME AND ASSISTANCE ASSISTANCE AT SCHOOL NO – DOES NOT NEED NO – BUT DOMAIN OF FUNCTIONAL DIFFICULTY SCHOOL NEEDS ONLY SEEING 84 0 13 0 3 HEARING 70 0 28 2 0 WALKING 78 1 20 0 1 SELF-CARE 82 1 15 1 1 COMMUNICATION 76 0 21 2 2 LEARNING 87 0 11 1 1 REMEMBERING 83 0 12 2 3 CONCENTRATING 88 0 12 0 0 ACCEPTING CHANGE 82 0 16 2 0 CONTROLLING BEHAVIOR 85 0 11 2 2 MAKING FRIENDS 79 0 15 2 4 ANXIETY 78 0 17 4 0 DEPRESSION 85 0 15 0 0 Of the children who have personal care assistance only at home, 73 percent are in regular schools, while 25 percent are in special schools, and 3 percent are in integrated schools. However, among children who receive such assistance at home and school, 53 percent are in regular schools, while 45 percent are in special schools. 72 | UNDERSTANDING MULTIDIMENSIONAL DETERMINANTS OF DISABILITY-INCLUSIVE EDUCATION: ACCOMMODATIONS FOR LEARNING NEEDS Among the cohort attending school (n=120), 51 percent of the respondents stated that their child had not received any accommodations or modifications for their learning needs in school despite needing accommodations. Only 17 percent in the study sample had received learning-related modifications, while one third (33 percent) stated that their children did not need accommodations for learning needs. Unmet needs for learning accommodations were highest in children with difficulties in the domains of seeing (78 percent), hearing (65 percent), learning (63 percent), accepting change (62 percent), communication (57 percent), and concentrating (56 percent). Children showing signs of anxiety (60 percent) and signs of depression (75 percent) also had high rates of not receiving accommodations for their learning needs. Figure 5.6: Children with Functional Difficulties Lacking Accommodations/Modifications for Learning Needs Zambia (%) 80 78 75 70 65 63 62 PERCENTAGE OF CHILDREN WITH DIFFERENT 60 60 57 56 54 53 50 46 44 FUNCTIONAL DIFFICULTIES 40 38 30 20 10 0 Seeing Hearing Walking Self-care Communicating Learning Remembering Concentrating Accepting change Controlling behavior Making friends Signs of anxiety Signs of depression TYPES OF FUNCTIONAL DIFFICULTIES Note: n=120 LESSONS FROM RWANDA, SIERRA LEONE, AND ZAMBIA | 73 Children across different types of schools had high unmet needs for learning accommodations and modifications. Children in special schools had slightly higher rates of accommodations than children in regular schools. Figure 5.7: Children Receiving Accommodations/Modifications for Learning Needs by Regular or Special School (Zambia) (%) 70 PERCENTAGE OF CHILDREN 60 58 50 39 39 40 30 28 22 20 14 10 0 Yes Need but do not receive Do not receive RECEIVING ACCOMMODATIONS/MODIFICATIONS FOR LEARNING NEEDS Regular school Special school Note: n=120 Among the small sample of children receiving learning accommodations (n=20), the accommodations included sign language interpretation (45 percent), adapted seating arrangements (35 percent), personal aides (25 percent), and assistive devices, such as visual and tactile aids (15 percent), e-readers, screen readers (15 percent), and communication boards (20 percent). The survey tried to understand if children with disabilities also had access to reading and learning materials at home. This is important to ensure their continuity of learning and access to materials at home like their peers without disabilities. Three fourths of the participants (75 percent) said their children did not have access to books at home in a format they can read, and 77 percent said their children did not have access to learning materials in preferred formats. However, 78 percent said their children were able to complete homework or study for examinations at home. The majority of the respondents (88 percent) said their child had access to toilets and other water and sanitation facilities at school. These numbers declined for children with walking (77 percent) and self-care difficulties (60 percent). Eighty-one percent stated their children received the support they needed with accessing water and sanitation facilities. ADDITIONAL EXPENSES FOR FAMILIES The survey asked respondents about the overall additional costs they incur to support the educational participation of their children with disabilities that they would not face for a child without disabilities. The highest additional out-of-pocket expenses were for assistive devices (64 percent), followed by transportation costs for adapted or accessible vehicles (53 percent), adapted learning materials (36 percent), and hiring personal assistants (32 percent). Figure 5.8 breaks down the costs by domain of functional difficulty. Parents and caregivers of children with functional difficulties hearing (72 percent), making friends (56 percent), communication (54 percent), controlling behavior (52 percent), and seeing (50 percent) and those showing signs of anxiety (54 percent) bore the highest additional costs for adapted learning materials. 74 | UNDERSTANDING MULTIDIMENSIONAL DETERMINANTS OF DISABILITY-INCLUSIVE EDUCATION: Figure 5.8: Additional Costs by Domain of Functional Difficulty (Zambia) (%) PERCENTAGE OF RESPONDENTS 0 20 40 60 80 90 100 Seeing Hearing Walking Self-care Additional transport Communicating DOMAIN OF FUNCTIONAL DIFFICULTY costs related to adapted/accessible vehicles Learning Hiring cost of personal assistant Remembering Out of pocket costs of assistive technology/ device(s) Concentrating Added costs of adapted learning materials Accepting change Controlling behaviour Making friends Signs of anxiety Signs of depression Note: n=120 LESSONS FROM RWANDA, SIERRA LEONE, AND ZAMBIA | 75 TRANSPORTATION TO SCHOOL AND COMMUNITY INFRASTRUCTURE The survey enquired about the participants’ perceptions of the overall accessibility of infrastructure in their communities. Forty percent stated that buildings in their community were accessible for persons with disabilities. Forty-seven percent stated that transportation in their community was accessible. Only 21 percent stated that rehabilitation resources and services were available in their communities (see table 5.3). Table 5.3: Perceptions of Community Accessibility Zambia (%) COMMUNITY ACCESS FEATURES DISTRICTS TOTAL(N=379) LUSAKA KITWE KAOMA Yes 40 40 69 5 Are buildings in your community accessible for persons/children No 39 47 18 47 with disabilities? Don’t know 21 13 13 47 Yes 47 49 70 18 Is transportation accessible? No 40 41 26 54 Don’t know 13 10 5 29 Yes 21 22 35 1 Are there rehabilitative resources No 39 50 10 48 and services available in your area? Don’t know 41 28 54 51 The majority of the children (76 percent) travelled to school on foot, and 32 percent used public or private buses not provided by the school. Children with difficulties in walking had higher rates of use of vehicular transportation than all other domains of functional difficulties. The majority of respondents (59 percent) said they did not have additional out-of-pocket expenses for accessible transportation to school. These figures vary by domain of functional difficulty, with most additional expenses incurred by parents and caregivers of children with difficulties in the domains of seeing (56 percent), walking (48 percent), and self-care (40 percent). ACCESS TO SOCIAL BENEFITS AND SCHEMES TO SUPPORT INCLUSIVE EDUCATION Forty-two percent of the parents and caregivers stated that their children had received their disability IDs or certification cards, while 9 percent had applied and were awaiting the documents. Close to half the sample (48 percent) had not yet applied for the disability certification, which was also noted by the Ministry of Education, stating that many families were hiding due to the attitudes of the community. The Ministry of Community Development noted that to enroll in the social protection scheme, children need proof of their disability, which must be identified through a disability assessment and proven by possession of a disability card. Forty percent of the respondents were unaware of any government benefits that support households with children with disabilities or their educational participation, and 36 percent were not sure. Only 7 percent of parents and caregivers stated that there were scholarships available for their children with disabilities to attend school. Lack of awareness among parents and caregivers was noted as the main barrier (95 percent) to accessing any government benefits that could support the needs of children with disabilities; however, this could be because those benefits are typically lacking in Zambia. 76 | UNDERSTANDING MULTIDIMENSIONAL DETERMINANTS OF DISABILITY-INCLUSIVE EDUCATION: The Ministry of Community Development pointed out that radio programs and community workers are used to sensitize the community on how to access social protection schemes. They also noted that they were aware that not everyone owns a radio and that the community workers are not able to reach some of the distant, isolated locations. Parents and caregivers who are receiving government benefits to support their children with disabilities cited costs for transportation (39 percent), hiring assistive devices (20 percent), and hiring personal assistants (10 percent) as additional out-of-pocket expenses incurred to access the benefits. The Ministry of Community Development noted that there are in fact cash transfer programs for persons with disabilities. This ministry [of community development] does offer social cash transfer to people with disabilities. This has made it easier to capture those who were hiding child with disabilities to come forward. This becomes an opportunity sensitize them about inclusive education. (Ministry of Community Development) The Ministry of Community Development mentioned that these cash transfers could go toward “supplementing school requirements or school fees” but also recognized that there were “too many to estimate” when asked how many children with disabilities potentially still need access to the social protection services and financial assistance to access schools. Table 5.4: Top Three Barriers to Accessing Benefit Schemes Zambia (%) BARRIERS TO ACCESSING BENEFIT SCHEMES DISTRICTS TOTAL (N=379) LUSAKA KITWE KAOMA Lack of awareness/knowledge about the scheme 95 93 95 100 Behavior of the program officials towards me 30 23 23 51 Language barrier 25 17 37 27 PARENTAL ATTITUDES, PERCEPTIONS, AND EXPERIENCES OF DISABILITY-INCLUSIVE EDUCATION All parents and caregivers agreed that children with disabilities have a right to education. This cuts across all the types of disabilities and towns. Participants also had high aspirations for their children’s educational outcomes. Ninety-seven percent hoped that their child would continue their education beyond high school, and 96 percent believed that a university education was important for their child’s future, with 80 percent of those with girls and 76 percent of those with boys strongly agreeing on the importance of a university education. Only a little over one third of the sample (36 percent) felt that their expectations for their child’s education had changed because of their child’s disability. The majority of the respondents (70 percent) stated that their children with disabilities aspired to higher educational attainment, with 69 percent saying that their children wanted to complete university or college-level education and 20 percent listing tertiary institutions. Of 124 parents and caregivers providing the sex of their child with a disability, 76 percent of respondents with boys and 65 percent of those with girls stated that their children aspired to university or college-level education. LESSONS FROM RWANDA, SIERRA LEONE, AND ZAMBIA | 77 Figure 5.9: Aspirations and Expectations for Children’s Education (Zambia) (%) 0 20 40 60 80 1 0 I hope my child will continue his/her 1 education after high school 29 68 1 0 1 My child is aware of my ideal 3 educational dreams for him/her 34 59 3 31 27 My expectations for my child’s education have 5 changed because of his or her disability 31 5 2 1 0 I believe that a university education is 1 important for my child’s future 33 63 2 Strongly Disagree Disagree Neither agree Agree Strongly agree Don’t know Note: n=120 The survey enquired about parents’ and caregivers’ confidence in their ability to successfully advocate for their child’s school to meet their learning needs. One third (33 percent) were quite confident, and 12 percent were extremely confident that they could ensure that their child’s school would meet their needs. Twenty-three percent were not confident at all, whereas 21 percent were slightly confident, and 11 percent were somewhat confident. Respondents with children in special schools were significantly more confident of their ability to ensure the school would meet the child’s needs (63 percent), compared to respondents with children in regular schools (35 percent). The integrated school model was the least frequently cited. Parents and caregivers of children with sensory and physical disabilities were confident of successfully advocating for their child’s needs, compared to parents of children with cognitive and intellectual disabilities, especially in the domains of learning (13 percent), accepting change (15 percent), concentrating (22 percent), and remembering (23 percent). 78 | UNDERSTANDING MULTIDIMENSIONAL DETERMINANTS OF DISABILITY-INCLUSIVE EDUCATION: Figure 5.10: Confidence in Ability to Ensure School Meets Child’s Needs by Type of School (Zambia) (%) 60 54 PERCENTAGE OF RESPONDENTS 50 40 36 30 21 20 21 22 14 11 8.2 9 10 4 0 Not confident at all Slightly confident Somewhat confident Quite confident Extremely confident LEVEL OF CONFIDENCE Regular school Special school Note: n=120 Parents and caregivers in the sample were quite involved in their children’s education. A majority (53 percent) helped with their child’s schoolwork on a weekly basis or more often, 14 percent helped monthly, and only 11 percent responded that they were never involved with their child’s schoolwork. Forty-three percent of respondents visited their child’s school weekly or more often, 38 percent visited once or twice a term, and 13 percent visited monthly. Respondents also identified specific actions that would help them be more involved in their child’s education, as listed in table 5.5. Table 5.5: Recommended Actions to Increase Parent/Caregiver Involvement in Education (Zambia) (%) ACTIONS TO INCREASE PARENT/CAREGIVER INVOLVEMENT IN EDUCATION PERCENT Involved in development of Individualized Education Plan 9 Assign homework that requires my child to talk with me about things learned in class 63 Send home clear notices that I can read easily 63 Contact me if my child is having problems in school or in class 78 Invite me personally to programs at the school 71 Parent visitation days to the school 28 Others (responses included more specialized training for teachers, financial assistance) 3 Parents and caregivers felt that their children were well included in mainstream academic activities, such as lessons, tests, and examinations (91 percent). Children with difficulties in remembering (77 percent), controlling behavior (77 percent), and making friends (72 percent) felt less included in schoolwork, compared to the sample aggregate. Perceptions of inclusion dropped for non-academic activities at school, such as participation in meals (68 percent), playtime and recess (66 percent), extracurricular activities including sports (63 percent), club activities (53 percent), educational tours and visits (51 percent), and arts such as music, dance, and drama (49 percent) (table 3.5). LESSONS FROM RWANDA, SIERRA LEONE, AND ZAMBIA | 79 The drops in inclusion in extracurricular activities are more prominent for different domains of functional difficulties. For example, only 33 percent of children with difficulties in walking, 20% of children with difficulties in making friends (20 percent), and 38% of children with difficulties in accepting change (38 percent) felt included in clubs. Children with mobility, intellectual, and learning disabilities also show significant drops in participation in extracurricular activities. See table 5.6 for inclusion by domains of functioning difficulties. The survey also asked about community engagement for the children, and 85 percent of respondents said their children have friends in the community. Table 5.6: : Inclusion in School Activities by Domain of Functional Difficulty (Zambia) (%) EDUCATIONAL TOURS/ MUSIC, DANCE, AND MEALS (if available) PLAYTIME/RECESS DRAMA FESTIVALS CLUB ACTIVITIES (lessons, tests, examinations) CLASSROOMS MAINSTREAM DOMAIN OF FUNCTIONAL DIFFICULTY FIELD VISITS SPORTS TOTAL (N=120) 91 68 66 63 53 51 49 SEEING 89 67 67 67 67 67 67 HEARING 94 82 59 82 65 53 65 WALKING 85 54 69 58 33 38 35 SELF-CARE 84 68 68 64 44 48 36 COMMUNICATION 92 65 57 65 59 38 38 LEARNING 81 50 56 56 56 31 31 REMEMBERING 77 54 69 46 54 46 31 CONCENTRATING 89 56 67 44 56 44 33 ACCEPTING CHANGE 92 46 46 54 38 23 23 CONTROLLING BEHAVIOR 77 46 54 54 46 46 38 MAKING FRIENDS 60 27 53 27 20 13 7 ANXIETY 100 80 60 80 60 80 60 DEPRESSION 100 75 75 100 75 75 75 80 | UNDERSTANDING MULTIDIMENSIONAL DETERMINANTS OF DISABILITY-INCLUSIVE EDUCATION: The majority of respondents (64 percent) are happy with their child’s experience at school. The survey asked respondents about their perceptions of the availability of community support and attitudes toward children with disabilities. The majority (75 percent) believed that their community was not supportive of families with children with disabilities. Respondents pointed to negative attitudes, stigma, and myths about disability as the main reasons for the perceived lack of support. Myths among community members about children with disabilities being bewitched, cursed, or a sign of evil, or negative perceptions about their future productivity were shared by parents and caregivers responding to the survey. However, 81 percent also stated that their community believes that children with disabilities should be in school. Sixty-three percent said that they do not receive help from community members to support their children’s educational needs. Only (34 percent) of respondents were aware of any support groups for parents of children with disabilities in their community, and 53 percent said they did not have informational resources available. About one fifth (23 percent) said they had access to training, workshops, or informational meetings on children with disabilities, and only 8 percent of the parents had contact lists for service providers. LESSONS FROM RWANDA, SIERRA LEONE, AND ZAMBIA | 81 6 82 | UNDERSTANDING MULTIDIMENSIONAL DETERMINANTS OF DISABILITY-INCLUSIVE EDUCATION: Source: Inclusive Education Initiative, World Bank. 6 6. CONCLUSION AND RECOMMENDATIONS Ratification of the CRPD in Sub-Saharan Africa is close to universal. Article 24 of the CRPD requires States Parties to offer inclusive learning environments and education systems for children with disabilities. Achieving inclusive education calls for changes and investments through a whole-systems approach, ensuring inclusion across the educational environment, including extracurricular activities, and through strong partnerships between families and teachers (CRPD/C/GC/4, 2016). As a result, countries across Africa have seen significant advancements in adopting legislative and policy frameworks to promote the education of children with disabilities, including through pivoting to supporting more children to go to regular schools than segregated learning environments. However, children with disabilities in Sub-Saharan African continue to be at higher risk of being out of school, dropping out of school, and achieving lower educational outcomes than their peers without disabilities. This study shows that while investments in the education systems and learning environments are essential, they may not be sufficient to ensure that children with disabilities can attend schools and participate fully in their educational environments. Children with disabilities feel more included in academic activities, but less so in recreational and extracurricular activities, which are also an integral part of the educational experience. A coordinated and holistic approach across social domains and within communities is necessary to realize disability-inclusive education. Findings from Rwanda, Sierra Leone, and Zambia showed that distances to school and the lack of affordable, accessible transportation are major reasons children do not enroll in school or drop out of school. The data showed that children with physical and mobility disabilities are not always the most heavily impacted by the lack of transportation options. In fact, children with difficulties in communication, controlling behavior, and making friends, or children showing signs of anxiety also face adverse impacts on their education participation due to a lack of accessible transportation options. Children with disabilities across all three countries have high unmet needs for assistive devices, with less than one quarter of the sample in the study using assistive devices. Children with difficulties in hearing, communication, and learning have less access to assistive devices across the three countries. NGOs are the dominant providers and funders of assistive devices, followed by families using their own funds, reflecting the findings of the literature review. Assistive devices maintain or improve an individual’s functioning and independence (World Bank, 2022), and for children who need assistive devices, they are an irreplaceable part of an inclusive learning environment (United Nations, 2016). These findings also raise the concern that children may receive sporadic or fragmented access to devices in the absence of robust public systems to support procurement and maintenance. According to the World Bank report “A Landscape Review of ICT for Disability- inclusive Education,” special schools were found to be better equipped, prepared, and more accessible to children with disabilities. Special schools also have greater access to information and communication technology (ICT) for inclusive education, whereas children attending mainstream or inclusive schools are less likely to have access to the technology they need. These findings call for additional investments by governments in developing assistive technology service delivery systems and rehabilitation services. These investments should include human resources to assess and match a child with the appropriate technology or device; train children, families, and teachers in using the devices; and support maintenance or replacement of the devices. Children with disabilities in the three countries had limited access to accommodations for learning needs and did not have reading and learning materials in adapted formats at home to support their continuity of learning between school and home. Many children who receive assistance with daily living activities at home do not have personal care assistance at school. While children in special schools had more access to personal assistance than in regular schools, many children in special schools also had unmet personal assistance needs. LESSONS FROM RWANDA, SIERRA LEONE, AND ZAMBIA | 83 Although the survey did not specifically ask for this information, the high rates of personal care assistance at home versus other environments suggests that family members are conducting the caregiving tasks. Literature shows that it is primarily families and female family members who take on the additional tasks of assisting children with disabilities with their daily living needs (Asa et al., 2020; Oti-Boadi, 2017; van der Mark et al., 2017). This impacts the family member’s ability to engage in paid work, and the lack of personal care aides outside of the family also limits a child’s ability to go to school. The high costs of securing external caregiver services are a significant out-of-pocket expense for persons with disabilities, not only in LMICs, but also in developed and high-income countries (Goodman, Morris, Morris & McGarity, 2020). Families of children with disabilities face significant additional costs in supporting their child’s education than they would for children without disabilities. Across all three countries, four categories consistently emerged as the primary causes of additional costs: additional costs for adapted learning materials, followed by transportation costs for adapted or accessible vehicles, assistive devices, and hiring personal assistants. Families with children with disabilities also cited expenses for school fees and other school-related costs as a reason for their children’s absence from school. Literature shows that families of children with disabilities often face hidden costs or levies in addition to school fees, or even when the school does not charge fees (USAID, 2020). Poverty is a key reason that children with disabilities do ot attend school and can be instrumental in parents’ decisions about school (Banks & Zuurmond, 2015). Facing a burden of additional and unaffordable costs for disability-inclusive education can further undermine families’ decision to invest in their child’s education and can become a significant challenge to realizing educational opportunities for children with disabilities. Social protection programs can play an important role in reducing the household impact of these costs (Mont & Cote, 2020). They can help parents and caregivers reduce costs that fall disproportionately on families and serve as incentives to maintain children’s attention and participation in school. Across all three countries, most families were not receiving social benefits to support their child’s educational costs and lacked awareness of available schemes and programs that could help them with these costs. These findings suggest limited educational financing to support additional accommodation-related costs as well as a need to embed more financial supports for education-related needs in social benefits or cash transfer programs aimed at households. There is a need to assess the additional out-of-pockets costs borne by families at the country level. The World Bank’s Inclusive Education Initiative is working in partnership with UNICEF and the International Disability Alliance to test a methodology to assess the additional costs of disability-inclusive education on families. Such assessments would help governments design social benefit programs to address these costs. Additionally, governments and development stakeholders must improve outreachprograms so that families are knowledgeable about the resources that can benefit their children with disabilities and how to acquire them. An encouraging and positive finding of this study is that almost all parents and caregivers believed in their child’s right to an education and had high aspirations for the educational success and achievement of their children with disabilities. This is a positive development over past studies that have shown that parents’ attitudes or negative perceptions of the ability of children with disabilities to have successful educational outcomes can limit their pursuit of inclusive education opportunities. This offers an important opportunity for governments, education practitioners, and civil society to support families in converting these aspirations into tangible and sustainable outcomes for children with disabilities. To do so, families and caregivers will need to have adequate opportunities to be informed, involved, and included in their children’s education. Parents and caregivers across the three countries expressed a lack of confidence in their ability to ensure that their child’s school would address their needs. It is important to strengthen the partnerships between teachers and partners to work as a team to identify and address the needs of children with disabilities. Parents and caregivers, and the larger community, should be viewed as crucial assets within the disability-inclusive education system. The study calls for further investment to ensure 84 | UNDERSTANDING MULTIDIMENSIONAL DETERMINANTS OF DISABILITY-INCLUSIVE EDUCATION: that families are knowledgeable and informed about how to access resources to support their children with disabilities, include them in decisions about their child’s advancement and growth at school, and aid them through targeted social programs so that household finances do not become the biggest roadblock to the education of children with disabilities. BOX 6.1: KEY RECOMMENDATIONS • and Governments must invest in developing assistive technology service delivery systems rehabilitation services. These investments should include human resources to assess and match a child with the appropriate technology or device; train children, families and teachers in using the devices; and support maintenance or replacement of the devices. •  Accessible public transportation and barrier-free environments in communities are essential to realizing the right to education for children with disabilities. Coordinated actions across ministries responsible for disability issues, education, urban development, and transportation are required to promote a whole-systems approach to disability- inclusive education. • to Inter-ministerial collaboration is needed to deliver a holistic, ecosystem-wide approach inclusive education so that children with disabilities can access learning-related accommodations and personal care assistance at home and school to optimize their continuity of learning and accommodations across the environments they inhabit. • benefits Social protection programs, including cash transfers, education stipends, and disability can play an important role in reducing the high costs that families face to support the educational needs of children with disabilities. This report makes a strong recommendation to government stakeholders to assess the additional out-of-pockets costs borne by families at the country level and design social benefit programs to address these costs, thus relieving the disproportionate monetary impacts on households of children with disabilities. •  Parents and caregivers need adequate opportunities to be informed, involved, and included in their children’s education. Governments, development practitioners, and civil society can offer targeted outreach, sensitization, and awareness raising programs so that families are knowledgeable about what resources can benefit their children and how to acquire them. LESSONS FROM RWANDA, SIERRA LEONE, AND ZAMBIA | 85 86 | UNDERSTANDING MULTIDIMENSIONAL DETERMINANTS OF DISABILITY-INCLUSIVE EDUCATION: Source: Inclusive Education Initiative, World Bank. REFERENCES Afoakwah, C. and Dauda, F. 2016. "Employment Status and Educational Attainment among Disabled Ghanaians." WIDER Working Paper 2016/56, UNU-WIDER., Helsinki. Afolabi, O.E. 2014. "Parents' Involvement in Inclusive Education: An Empirical Test for the Psycho-Educational Development of Learners with Special Education Needs (SENs)." International Journal of Educational Administration and Policy Studies 6 (10): 196-208. Ahmad, F. K. 2015. "Use of AssistiveTechnology in Inclusive Education: Making Room for Diverse Learning Needs." Transcience, 6(2) 62-77. Asa GA, Fauk NK, Ward PR, Mwanri L. 2020. "The psychosocial and economic impacts on female caregivers and families caring for children with a disability in Belu District, Indonesia." PLoS ONE, 15(11). Banks, L. M. and Zuurmond, M. 2015. "Barriers and enablers to inclusion in education for children with disabilities in Malawi." Norwegian Association of Disabled. Banks, L. M., Mearkle, R., et al. 2017. "Disability and social protection programmes in low-and middle- income countries: a systematic review." Oxford Development Studies, 45(3), 223-239. Botelho, F.H.F. 2021. "Childhood and Assistive Technology: Growing with opportunity, developing with technology." Assistive Technology 87-93. doi:DOI: 10.1080/10400435.2021.1971330. Branson, N., & Lam, D. 2017. "The impact of the no-fee school policy on enrolment and school performance: Evidence from NIDS Waves 1-3." Chatzitheochari, S., & Platt, L. 2018. "Childhood disability & educational attainment the impact of parental expectations and bullying." Warwick Social Sciences Policy Briefing-April 2018. Chavuta, A., Itimu-Phiri, A. N., Chiwaya, S., Sikero, N., & Alindiamao, G. 2008. Montfort Special Needs Education College and Leonard Cheshire Disability International. Chiwandire, D., & Vincent, L. 2019. "Funding and inclusion in higher education institutions for students with disabilities." 8: 1-12. Coleman, J. 1968. "The concept of equality of educational opportunity." Harvard Educational Review 38(1): 7-22. Cote, A. 2021. "Social protection and access to assistive technology in low- and middle-income countries." Assistive Technology (33:sup1): S102-S108. Franck, B., & Joshi, D. K. 2017. "Including students with disabilities in education for all: Lessons from Ethiopia." International Journal of Inclusive Education 21(4): 347-360. Goodman, N., Morris, M., Morris, Z., & McGarity, S. 2020. "The Extra Costs of Living with a Disability in the U.S.—Resetting the Policy Table." https://www.nationaldisabilityinstitute.org/wp-content/uploads/2020/10/ extra-costs-living-with-disability-brief.pdf. Hill, N. E. et al. 2004. "Parent academic involvement as related to school behavior, achievement, and aspirations: Demographic variations across adolescence." Child development 75(5): 1491-1509. Inguanzo, I. 2017. "The situation of indigenous children with disabilities." Policy Department, Directorate- General for External Policies, European Union. LESSONS FROM RWANDA, SIERRA LEONE, AND ZAMBIA | 87 International Labour Organization. 2013. Inclusion of People with Disabilities in Ethiopia: Fact Sheet. ILO/ Irish Aid Partnership Programme. International Labour Organization. 2015. Inclusion of people with disabilities in national employment policies. https://www.ilo.org/wcmsp5/groups/public/---ed_emp/---ifp_skills/documents/publication/wcms_407646.pdf Light for the World and IDDC. 2016. "Costing Equity: The Case for Disability-responsive Education Financing." Accessed June 24, 2022. https://www.light-for-the-world.org/publications/costing-equity-report-iddc/. Malpel, J. 2016. PASEC 2014: Education system Performance in Francophone Sub-Saharan Africa: Competencies and Learning Factors in Primary Education. Dakar, Sénégal: Programme d’Analyse des Systèmes Educatifs de la CONFEMEN. Mattingly, J., & Ratsifandrihamanana, L. 2016. A study on children with disabilities and their right to education: Madagascar. Education Development Trust. Ministry of Basic and Senior Secondary Education, Sierra Leone. 2021. National Policy on Radical Inclusion in Schools. https://mbsse.gov.sl/wp-content/uploads/2021/04/Radical-Inclusion-Policy.pdf Ministry of Community Development, Mother and Child Health, Republic of Zambia. 2012. National Policy on Disability. "Empowering Persons with Disabilities." https://www.mcdss.gov.zm/wp-content/ uploads/2021/06/National-Disability-on-Policy.pdf Ministry of Community Development and Social Services, Republic of Zambia. 2018. "Zambia National Disability Survey 2015." https://www.unicef.org/zambia/media/1141/file/Zambia-disability-survey-2015.pdf. Ministry of Education, Republic of Rwanda. 2022. 2020/21 Education Statistical Yearbook. https://mineduc. prod.risa.rw/index.php?eID=dumpFile&t=f&f=41941&token=f2b4cacbfa02e2c86fe309244c7e416180c4d28a Ministry of Education, Republic of Rwanda, & UNICEF. 2017. Understanding Repetition and Dropout in Basic Education in Rwanda. http://www.rencp.org/wp-content/uploads/2018/09/DROPOUT-STUDY-FULL- REPORT.pdf Ministry of Education, Republic of Rwanda (MINEDUC), UNICEF, & Education Development Trust. 2016. "A Study on Children with Disabilities and their Right to Education: Republic of Rwanda." https://www.unicef. org/esa/media/1711/file/UNICEF-EDT-Rwanda-2016-children-with-disabilities.pdf. Mitra, S., et al. 2017. "Extra costs of living with a disability: A review and agenda for research." Disability and Health Journey 10(4): 475-484. Moberg, S. 2003. "Education for all in the North and the South: Teachers' attitudes towards inclusive education in Finland and Zambia." Education and Training in Developmental Disabilities 417-428. Mont, D., & Cote, A. 2020. Considering the Disability related Extra Costs in Social Protection. Developed for UNPRPD, Innovation to Inclusion, Leonard Cheshire, and UKAid. https://www.social-protection.org/gimi/ RessourcePDF.action?id=56925. National Institute of Statistics of Rwanda. 2014. "RPHC4 Thematic Report: Socio-economic Characteristics of Persons with Disabilities." https://www.statistics.gov.rw/publication/rphc4-thematic-report-socio- economic-characteristics-persons-disabilities. Nishimuko, M. 2014. "How Can Children with Disabilities be Included in School Education?: A Case in Sierra Leone." Journal of International Cooperation in Education 16 (2): 71-85. Nyoni, M., Nyoni, T., & Bonga, W. G. 2017. "Factors Affecting Students’ Academic Achievement in Zimbabwe's Rural Secondary Schools: A Case Study of Marimasimbe Secondary School in Jiri Community." 88 | UNDERSTANDING MULTIDIMENSIONAL DETERMINANTS OF DISABILITY-INCLUSIVE EDUCATION: 2011. "Organic Law N°02/2011/OL OF 27/07/2011 Governing Organisation of Education." Rwanda Official Gazette 34. https://planipolis.iiep.unesco.org/sites/default/files/ressources/rwanda_organic_law_2011.pdf. Oti-Boadi, M. 2017. "Exploring the lived experiences of mothers of children with intellectual disability in Ghana." SAGE Open 7 (4). Republic of Zambia, Ministry of Education. 1996. Educating out Future. National Policy on Education. http://155.0.32.9:8080/jspui/bitstream/123456789/20/1/Educating%20Our%20Future%20-%20National%20 Policy%20on%20Education.pdf Rohwerder, B. 2018. "Assistive technologies in developing countries." Institute of Development Studies. https://assets.publishing.service.gov.uk/media/5af976ab40f0b622d4e9810f/Assistive_technologies_in_ developing-countries.pdf. Rwanda Union of the Blind. 2019. Report on the Extent to Which Rwanda’s Implementation of the SDGs Complies with its Obligations Under the CRPD. Statistics Sierra Leone. 2015. Population and Housing Census Thematic Report on Disability. https:// sierraleone.unfpa.org/sites/default/files/pub-pdf/Disability%20Report.pdf. Taderera, C. & Hall, H. 2017. "Challenges faced by parents of children with learning disabilities in Opuwo, Namibia." African Journal of Disability 6 (0): a283. Tangcharoensathien, V. et al. 2018. Improving access to assistive technologies: challenges and solutions in low- and middle-income countries. Thailand: International Health Policy Program, Ministry of Public Health. The Child Right Act 2007, Supplement to the Sierra Leone Gazette Extraordinary Vol. CXXXVIII, No. 43 dated 3rd September, 2007 (2007). The Education Act 2004, Supplement to the Sierra Leone Gazette Vol. CXXXV, No. 19 dated 1st April, 2004 (2004). The Persons with Disability Act 2011, Supplement to the Sierra Leone Gazette Vol. CXLII, No. 22 dated 5th May, 2011 (2011). The Persons with Disabilities Act, 2012, [No. 6 of 2012], Government of Zambia (2012). The World Bank. 2020. "Creating Disability-Inclusive ID System." Washington D.C. http://hdl.handle. net/10986/34848. The World Bank, UNESCO and UNICEF. 2021. The State of the Global Education Crisis: A Path to Recovery. Washington D.C., Paris, New York: The World Bank, UNESCO, and UNICEF. United Nations Children's Fund (UNICEF). 2018. "Situation analysis of children in Rwanda 2017." https:// www.unicef.org/rwanda/media/391/file/Situation-Analysis-of-Children-in-Rwanda-Summary.pdf. UNICEF. 2019. "Do children with disabilities attend school? New findings from Sierra Leone." UNICEF. 2021. Seen, Counted, Included: Using data to shed light on the well-being of children with disabilities. New York: UNICEF. United Nations Committee on the Rights of Persons with Disabilities (CRPD). 2016. "Article 24: Right to inclusive education." General comment No. 4 (CRPD/C/GC/4). United Nations Department of Economic and Social Affairs (DESA). 2018. "Disability and Development Report." https://social.un.org/publications/UN-Flagship-Report-Disability-Final.pdf. United Nations Population Fund Sierra Leone. 2017. "Sierra Leone Population and Housing Census Thematic Reports on Disability." Accessed June 27, 2022. https://sierraleone.unfpa.org/en/publications/sierra-leone- population-and-housing-census-thematic-reports-disability. United States Agency for International Development (USAID). 2020. "Are we fulfilling our promises? Inclusive education in Sub-Saharan Africa." Education Links. https://www.edu-links.org/resources/are-we- fulfilling-our-promises-inclusive-education-sub-saharan-africa. van der Mark, E.J., Conradie, I., Dedding, C.W.M., & Broerse, J.E.W. 2019. "We create our own small world’: daily realities of mothers of disabled children in a South African urban settlement." Disability & Society, 34:1 95-120. Washington Group on Disability Statistics. 2022. WG/UNICEF Child Functioning Module (CFM). https://www. washingtongroup-disability.com/question-sets/wg-unicef-child-functioning-module-cfm/ Wodon, Q., Male, C., Montenegro, C., & Nayihouba, A. 2018. The Challenge of Inclusive Education in Sub- Saharan Africa.. Washington, DC: World Bank,. https://openknowledge.worldbank.org/handle/10986/31005 License: CC BY 3.0 IGO. World Health Organization. 2016. Priority Assistive Products List. Geneva: World Health Organization. World Health Organization. 2018. "Improving access to assistive technology. Draft resolution proposed by Algeria, China, Costa Rica, Ecuador, Ethiopia, France, Germany, Ghana, Iraq, Israel, Jamaica, Pakistan, Philippines, Zambia." 90 | UNDERSTANDING MULTIDIMENSIONAL DETERMINANTS OF DISABILITY-INCLUSIVE EDUCATION: LESSONS FROM RWANDA, SIERRA LEONE, AND ZAMBIA | 91 Source: Deepti Samant Raja, World Bank. 92 | UNDERSTANDING MULTIDIMENSIONAL DETERMINANTS OF DISABILITY-INCLUSIVE EDUCATION: Source: “Milcah Owour, supported through Girls Education Challenge in Kenya.” Jenny Matthews, Leonard Cheshire Disability. APPENDIX A: DETAILED METHODOLOGY The study used a mixed methods approach, combining qualitative and quantitative methods. 1. A regional online survey of parents and caregivers of children with disabilities: The anonymous online survey targeted parents and caregivers of children with disabilities across Sub-Saharan Africa to understand: a. The experiences of children with disabilities in accessing educational facilities and resources b. The availability of learning supports, such as assistive devices, at school and at home c. The needs of and resources available to support children and families A scripted CAWI questionnaire was disseminated online in English and French between December 13, 2021 and January 14, 2022. The survey links were sent out in English, Portuguese, and French. Overall, 225 surveys were opened, but only 178 interviews were completed across the different countries. Of the 178 eligible responses, 137 were in English and 52 in French. The survey was also disseminated in Portuguese but did not receive responses. The survey was widely disseminated through organizations of persons with disabilities, and organizations focusing on disability-inclusive education were invited to share it with parents and caregivers in their networks and with other networks with which they work across the region. 2. Country case studies The study primarily targeted parents and caregivers of children with disabilities in regular, special, and integrated schools to assess the implementation of policies relating to inclusive education and the assistance provided to children with disabilities to facilitate progress with their education. In addition, the study included key informants from government stakeholders, education practitioners, and organizations of persons with disabilities. Table A.1 depicts the process for selecting stakeholder groups. Table A.1: Stakeholder Groups OBJECTIVE RESPONDENT (S) ANSWERING TO OBJECTIVE METHOD - Government officials; -Ministry of Education (Officer in charge of inclusive education) KIIs Assessment of policy and legislative environment for -Ministry of Social Welfare/related (Officer in charge inclusive education. of the welfare of persons with disabilities) - Organizations of Persons with Disabilities (OPDs) KIIs - Community Disability Committees KIIs - Government officials; - Ministry of Education (Officer in charge of inclusive KIIs Assessment of current status of educational education) inclusion and attainment of children with disabilities: Enrollment, retention, and completion rates for - School administrators (Special schools) KIIs children with disabilities in primary education and disability inclusion in education data systems - School administrators (Regular schools) KIIs - Itinerant/resource teachers KIIs - Government officials -Ministry of Education (Officer in charge of inclusive education) KIIs Assessment of current status of educational -Ministry of Social Welfare/related (Officer in charge inclusion and attainment of children with disabilities: of the welfare of persons with disabilities) Multidimensional determinants of disability-inclusive education: household and community level resources Quantitative that can support primary educational attainment for - Parents/caregivers surveys children with disabilities - OPDs KIIs - Community Disability Committees KIIs LESSONS FROM RWANDA, SIERRA LEONE, AND ZAMBIA | 93 Country-based data collection was conducted in three provinces or regions per country, with each district located in a different region of the country (table A.2). Each district was chosen with the inputs of government officials and local partners and included a combination of urban, peri-urban, and rural areas. Questionnaires were translated into local languages. Respondents were selected with the assistance of World Bank country teams, the Ministries of Education, and local OPDs. Appropriate research permissions and ethics approvals were obtained in all three countries. Table A.2: District Selection for Study Sample PROVINCE/REGION DISTRICT TARGET POPULATION RWANDA Southern province Huye Rural Kigali City Kigali Urban & peri-urban Western province Rubavu Urban & rural SIERRA LEONE Western province Freetown Urban & peri-urban Southern province Bo Urban & rural Eastern province Kenema Rural ZAMBIA Lusaka Lusaka Urban & peri-urban Copperbelt province Kitwe Urban & rural Western province Kaoma Rural An in-depth quantitative survey was conducted of parents and caregivers of children with disabilities in primary school or of primary school age. The survey included parents and caregivers with children currently in school, as well as those whose children had never attended or dropped out of primary school. This allowed the study to capture barriers to school attendance. Sample sizes were proportionate to the population of the country, with the distribution as shown in table A.3. Table A.3: Distribution of Survey Participants COUNTRY POPULATION SAMPLE Rwanda 12,300,000 Estimated: 270; Achieved: 271 Zambia 17,381,168 Estimated: 380; Achieved: 379 Sierra Leone 7,092,113 Estimated: 160; Achieved: 162 TOTAL SAMPLE 812 94 | UNDERSTANDING MULTIDIMENSIONAL DETERMINANTS OF DISABILITY-INCLUSIVE EDUCATION: SAMPLING METHOD FOR QUANTITATIVE SURVEYS The research team used a combination of stratified and systematic sampling. To identify the respondents—in this case parents/caregivers of children with disabilities—the research team worked with local OPDs, local administration authorities, and special schools to obtain a list of persons with disabilities in each administrative area. Face-to-face surveys were conducted in Rwanda, Sierra Leone, and Zambia through Computer-Assisted Personal Interviews (CAPI). This is a face-to-face data collection method in which the interviewers used a tablet to record answers given during the interviews. The caregivers were targeted using different sampling strategies in each of the countries. In Rwanda and Zambia, the local OPDs guided the interviewers in recruiting respondents. The OPDs at the national level introduced the Pan African Research Services (PARS) team to the local OPDs in each of the districts identified. The districts were initially divided into clusters, and the sample size was proportionately distributed to the total number of caregivers with children with disabilities in each. At the household level, a screener questionnaire was used to ensure that the caregivers met the respondent criteria. The screener questionnaire, which formed the basis of the respondent criteria, included the age of the respondent, whether they were caregivers to a child with disabilities, and their relationship to the child with disabilities. Each primary caregiver was asked for consent prior to commencing the interview. In Sierra Leone, introduction to the local OPDs took longer than anticipated, therefore, the Ministry of Education personnel provided a list of a sample of randomly selected schools with children with disabilities in addition to the contacts received through OPDs. At these schools, the enumerators asked to be connected with the caregivers of the children with disabilities, after which the proceeded with the screener questionnaire prior to commencing the interviews. Across all three countries, local languages were used to conduct the interviews: Krio in Sierra Leone, Kinyarwanda and French in Rwanda, and Bemba, Nyanja, and Lozi in Zambia. However, in a few instances, some of the respondents in Zambia were interviewed in English as it is the official language in the country, and a larger part of the population is comfortable conversing in English. SAMPLING METHOD FOR KIIS KIIs were conducted by using a discussion guide prepared for each respondent category, depending on the information required from them. The KIIs mainly targeted government officials and key stakeholders in different organizations. However, due to CovCOVIDid-19 containment measures, some of the KIIs were conducted virtually (through Skype, Zoom, MS Teams, or telephone), while others were conducted in person based on the respondents’ availability. The respondents in this phase of the interview were purposely selected through snowball sampling and emails. The snowballing exercise was conducted with the assistance of World Bank country teams, Ministry of Education stakeholders as well as OPDs. In Zambia, all the KIIs were conducted in English, while in Rwanda and Sierra Leone, both English and local languages were used based on the respondents’ preference. The final sample breakdown is provided in table A.4. LESSONS FROM RWANDA, SIERRA LEONE, AND ZAMBIA | 95 Table A.4: KII Sample in Each Country RESPONDENT CATEGORY CATEGORY ZAMBIA SIERRA LEONE RWANDA QUALITATIVE INTERVIEWS Ministry of Education 1 1 1 Government Officials Ministry of Social 1 1 1 Welfare/related OPD 4 3 1 Disabled Organizations CDC 3 3 3 Special Schools 5 5 4 School administrators Regular Schools 6 6 7 Itinerant/resource Teachers 1 6 6 teachers Total 21 25 23 96 | UNDERSTANDING MULTIDIMENSIONAL DETERMINANTS OF DISABILITY-INCLUSIVE EDUCATION:  WANDA–LIST OF POLICIES RELATED APPENDIX B: R TO INCLUSIVE EDUCATION POLICY, STRATEGY, PLAN DESCRIPTION CRPD + OPTIONAL PROTOCOL RATIFIED BOTH Every Rwandan citizen has the right to education. Primary Education is free and compulsory in public Constitution schools. Discrimination on any grounds, including disability, is prohibited. Specifies the right of persons with disabilities in Rwanda to an “appropriate education in respect of the nature of his or her disability” Law 01/2007 Also states that “disabled persons who are not able to study with others” shall be provided the modalities to study in specialized schools with qualified, trained teachers and appropriate equipment Intends to provide quality education for all learners who may, for any reason, have a temporary or permanent need for adjusted educational services. Strategic goals include improved access, retention, Special Needs and Inclusive Edu- and completion of schooling, development of cation Policy 2018 support services through schools of excellence in special and inclusive education, promotion of special needs and inclusive education quality services, and promotion of inclusive and child- friendly approaches Equitable opportunities for all Rwandan children Education Sector Strategic Plan and young people at all levels of education with 2018/19–2023/24 disability-specific outcomes and outputs Builds on the government’s commitment to National Policy of Persons with empower, support, and promote the inclusion of Disabilities and Four Years Strate- persons with disabilities across the country, which gic Plan (2021–2024) includes the education of children with disabilities LESSONS FROM RWANDA, SIERRA LEONE, AND ZAMBIA | 97 The Education Sector Strategic Plan 2018/19–2023/2024 ensures that Rwandan citizens have sufficient and appropriate competencies to drive the continued social and economic transformation of the country. A strategic priority outlined is “equitable opportunities for all Rwandan children and young people at all levels of education.” The following table lists disability-specific outcomes and outputs. PRIORITY 7: EQUITABLE OPPORTUNITIES FOR ALL RWANDAN CHILDREN AND YOUNG PEOPLE AT ALL LEVELS OF EDUCATION OUTCOME OUTPUTS 7.2 Increase the participation Number of schools/colleges that meet standards of and achievements of chil- accessibility for learners with disabilities increased dren with disabilities and Special Educational Needs (SEN) at all levels Number of schools/TVET and HEIs (Higher Education Institutions) that have adapted teaching and learning materials for learners with special educational needs increased All Teacher Training Colleges and Teacher Training Institutions include components on inclusive education, and teachers are also provided with in-service and CPD (continuous professional development) opportunities All schools have at least one teacher competent in inclusive education All teachers identify learners with special educational needs and take action to ensure needs are met Additional assistance provided in schools and/or special units within schools for children with severe learning needs Supply of assistive devices and services to support access and learning of learners with disabilities and those with special educational needs increased Number of children with special educational needs sitting national exams increased 98 | UNDERSTANDING MULTIDIMENSIONAL DETERMINANTS OF DISABILITY-INCLUSIVE EDUCATION:  IERRA LEONE–LIST OF POLICIES APPENDIX C: S RELATED TO INCLUSIVE EDUCATION POLICY, STRATEGY, PLAN Description CRPD + OPTIONAL PROTOCOL RATIFIED CRPD AND SIGNED OPTIONAL PROTOCOL Ensures that there are equal rights and adequate educa- tional opportunities for all citizens at all levels Constitution Special emphasis is paid to the protection and promotion of the rights of vulnerable groups, including persons with disabilities Forbids discrimination of children with disabilities for ad- mission into and participation in basic education Education Act of 2004 Mandates the National Commission for Basic Education to protect the right to basic education for all citizens, with an emphasis on persons with disabilities Contains a disability-specific provision on the education Child Rights Act 2007 of children with disabilities and stipulates remedies for its violation Provides a comprehensive legal framework for the protec- tion of the rights of persons with disabilities, including in the domain of education Persons with Disabilities Act 2011 Requires educational institutions to take into account learners’ special educational needs in terms of infrastruc- ture and pedagogical inclusion Frames inclusion as a process of addressing and responding to the diverse needs of all learners by increasing participa- National Policy on Radical tion in learning, culture, and community and reducing ex- Inclusion in Schools clusion within and from education, and places the responsi- bility to education of all children on the regular system LESSONS FROM RWANDA, SIERRA LEONE, AND ZAMBIA | 99  AMBIA–LIST OF POLICIES RELATED TO APPENDIX D: Z INCLUSIVE EDUCATION POLICY, STRATEGY, PLAN DESCRIPTION CRPD + OPTIONAL PROTOCOL RATIFIED CRPD AND SIGNED OPTIONAL PROTOCOL Very limited direct articulation of disability rights issues, but Constitution includes definition that aligns with CRPD In addition to inclusive schools, it explicitly recognizes special schools and requires the government to establish them for learners who “by reason of their disability, cannot be enrolled in inclusive educational institutions.” Mandates the minister to designate public educational institu- Persons with Disabilities Act tions to provide the necessary facilities and equipment to enable persons with disabilities to fully benefit from the public educa- tional institutions. Prescribes a zero-rejection policy for admission to regular schools, but gives the Ministry of Health responsibility to assess persons who might be sent to special schools Reaffirms that every individual has an equal right to educational opportunity regardless of personal circumstance or capacity Educating Our Future Education Policy Explicitly recognizes children with disabilities as exceptional, differing from other students in “mental, physical, or social char- acteristics” National Policy on Disability Envisages persons with disabilities enjoying equal opportunities 2013 that are fundamental for living and development To be used as a model to the government of how policies and National Disability legislation concerning persons with disabilities could be used Implementation Plan to ensure that the needs of persons with disabilities are main- streamed Includes a strategy to enhance access to quality, equitable, and National Development Plan inclusive education, which includes children with disabilities and 2017-2021 special needs through investments in infrastructure and use of innovative methods of delivering education Zambia Education Curriculum Framework 2013 100 | UNDERSTANDING MULTIDIMENSIONAL DETERMINANTS OF DISABILITY-INCLUSIVE EDUCATION: LESSONS FROM RWANDA, SIERRA LEONE, AND ZAMBIA | 101 Source: Inclusive Education Initiative, World Bank.