A Review of Disability Protection in Nepal Through Social Allowance: Policies, Practices, and Paucity

Abstract

This paper endeavors to paint a comprehensive picture of the social security provision of allowances for persons with disabilities in Nepal. It uses a rapid review to understand the policies and practices related to the social security allowances. The key findings are that the Government of Nepal has several policies focused on upholding the rights of the persons with disabilities; it has prioritized disability allowance as one of the five government-run social security allowances, but the benefits of these policies are yet to reach all persons with disabilities. It was found that a significant proportion of persons with disabilities are yet to receive disability identity cards that link them with social security benefits, and a significant gap was also noted between those who had the identity cards and those who received the disability allowances. Furthermore, the paper underscores suggestions from the extant literature on minimizing this gap.

1. Introduction

About 16% of the world’s population (an estimated 1.3 billion people) currently experience significant disability (WHO 2024). The United Nations Economic and Social Commission for Asia and the Pacific (UNESCAP 2019) established that about 690 million persons (one in every six persons) live with disabilities in Asia and the Pacific. Gudlavalleti (2018) expresses that the projected magnitude of disability in South Asia is approximately between 1.6 and 2.1% when the impairment focus is highlighted and between 3.5 and 15.6% when functionality is highlighted.

The National Population and Housing Census 2021 reported that 2.2% of the total population in Nepal was living with a disability, among which 54.2 percent are males and 45.8 percent are females (NSO 2021). The 2021 Census further reported that 33.5% of Nepalese population with disability had a physical disability as compared to 1.9% with an intellectual disability, i.e., in 2021, the population of persons with physical disabilities was twenty times higher than that of persons with intellectual disabilities. Thapaliya (2016) reported that, according to the 2011 Census, the population of persons with physical disabilities was ten times higher than the population of persons with mental disabilities. The figures on disability prevalence at all levels could be an underestimate. UNESCAP (2019) estimates that disability prevalence in Asia and the Pacific is underestimated by 450 million persons, and Thapaliya (2016) speculates the actual figures in Nepal to be higher because of various limitations in data collection, for example, a lack of understanding of defining disability. Thapaliya (2016) further adds that people often hide their disability due to socio-cultural norms, values, and pressures.

The World Health Organization (WHO 2011) defines disability as a part of human condition that is complex and flags that almost everyone will experience disability at some point in life, either temporarily or permanently. In the Nepalese context, The Act Relating to Rights of Persons with Disabilities 2017 (2017) defines a person with disability as “a person who has long-term physical, mental, intellectual or sensory disability or functional impairments or existing barriers that may hinder his or her full and effective participation in social life on an equal basis with others” (pp. 1–2). While the 2011 Census Report of Nepal classified disability into seven distinct groups: physical disability, vision-related disability, hearing-related disability, deaf–blind, voice- and speech-related disability, mental disability, and multiple disabilities (Thapaliya 2016). The National Population and Housing Census 2021 classified the country’s population into twelve distinct groups: physical disability, low vision, blind, deaf, hard of hearing, deaf and blind, speech problem, mental or manosamajik [psychosocial], intellectual disability, hemophilia, autism, and multiple disability (NSO 2021). This significant expansion of classification categories bears testimony to the Government of Nepal’s increased awareness about persons with disabilities.

1.1. Statement of the Problem

Mitra et al. (2013) in their study of persons with disabilities from 15 developing countries found that disability was significantly associated with higher multidimensional poverty in most of the countries; persons aged 40 and above and persons with multiple disabilities were more likely to be multidimensionally poor; persons with disabilities have lower educational attainment and experience lower employment rates than persons without disabilities; and persons with disabilities account for sizeable portions of the working-age population in developing countries (above 5% in most of the countries included in the study). Eide et al. (2016) found a few similarities in Nepal where only a few persons with disabilities accessed formal education system and tended to stay shorter at school, resulting in lower literacy levels, and persons with disabilities exhibited higher unemployment and earned significantly less than persons without disability, when receiving a regular income.

People with disabilities face significant challenges in accessing health care in the South Asian region (Gudlavalleti 2018). Along these lines, Eide et al. (2016) found persons with disabilities in Nepal to have more health problems, poorer physical and mental health, lower well-being, lesser access to health information, and experienced substantial gaps in services as compared to the control individuals. Persons with disabilities also struggle with the negative impacts of disasters. Borg et al. (2013) through their review also confirmed that people with disabilities experience problems in the domains of access to justice and the rule of law, labor rights, and business rights.

Mitra et al. (2017) underscore that persons with disabilities have significant extra costs that vary across severity of disability, life cycle, and household composition where persons with several disabilities are associated with higher costs, including overall disability costs, health-related expenditures, assistance with daily care costs, and transportation costs. Importantly, the participation of persons with disabilities in employment is reduced as compared to that of the general population, increasing the likelihood of becoming financially dependent on the family (Rana et al. 2022). Banks et al. (2021) flagged that persons with disabilities will be disproportionately affected by the economic implications of the COVID-19 pandemic unless disability-inclusive responses are in place. Because of the multiple disadvantages associated with disability, various states establish social security measures to support these disproportionately affected population, and disability allowances or cash transfers is such an endeavor. Gooding and Marriot (2009) identified that social empowerment or improvement in status within the household, increased access to health services, and increased economic security to be the prominent impacts of cash transfers to persons with disabilities.

1.2. The Nepalese Context

Social protection in Nepal aims towards maintaining equity among citizens and ensuring a decent life for them (Khadka 2017). Social protection in Nepal has two functions: (i) alleviating income deprivation (e.g., through cash transfers) and (ii) fostering broader social inclusion (e.g., through educational scholarships, health care discounts, employment support) (Khanal 2013). However, the undertaking of the responsibility to protect the rights of persons with disabilities by the state is a comparatively new phenomenon for Nepal. The Disabled Persons Protection and Welfare Act (DPWA), 1982, was the first legislation enacted in Nepal following the declaration of the United Nations to celebrate the year 1981 as The International Year of Disabled Persons (Baral 2018; Timilsana 2018). This Act stated the following:

“Disabled person” means a Nepalese citizen who is physically or mentally unable or handicapped to do normal daily lifework. The expression also includes a blind, one eyed, deaf, dumb, dull, crippled, limb, lame, handicapped with one leg broken, handicapped with one hand broken or a feeble minded person. (p. 1)

The Act envisioned providing for the protection and welfare of persons with disabilities and laid out provisions for determining disability, ensuring their right to equality, provisions for education and training, health and medical treatment, training and employment, facilities and concessions, and prioritizing persons with disabilities.

The Act Relating to Rights of Persons with Disabilities 2017 is the primary legislation that upholds the rights of persons with disabilities in Nepal. The Act (Chapter 10) spells out that the Government of Nepal, Provincial Government, and Local Levels shall bear the responsibility to “implement, or cause to be implemented, effectively the rights of the persons with disabilities” (p. 26). The provisions outlined in this Act include free education, free medical examination in all state hospitals, prioritization at employment in government and semi-government institutions based on their education, training, and physical position and ensuring non-discrimination in remuneration, facilities, and service conditions, providing a loan of 5k–20k without collateral through Social Welfare Council—for skills-based self-employment—and free legal aid to persons with disabilities. Additionally, DPWA directed for a reservation of 5% of total seats in technical and vocation training programs in each government and semi-government institution without any costs; reservation of at least two free beds—in any hospital with more than 50 beds—for the treatment of persons with disabilities; and at least a five per cent reservation in appropriate work for the disabled persons according to their physical capacity, training, qualification, and experience to be allocated in an industrial enterprise having more than 25 employees (Baral 2018; Timilsana 2018). Despite all these provisions, the everyday struggles for persons with disabilities in Nepal are manifold.

One of the major concerns relates to the ambiguities in roles and responsibilities across government levels in Nepal contributing to the incomplete implementation of policies (Adhikari 2019 in Sapkota 2024). Invisibility of persons with disabilities in the Nepali society is another prominent issue because of the prevalence of stigma, discrimination, and inaccessibility; disability is deeply associated with sinful activities of past life (Eide et al. 2016; UN 2018). Majority of persons with disabilities in Nepal were found to be associated with economically weak communities and had minimal access to education; persons from rural communities were noted to suffer a greater disadvantage, and persons with severe disabilities visibly experienced a vicious cycle of almost non-existent access to developmental activities, illiteracy, unemployment, and therefore a low standard of living (Eide et al. 2016). The latest National Census displays that the situation remains unchanged with only 50.15% persons with disabilities (5 years and above) being literate, 8.1% with a qualification equivalent to SEE/S.L.C., and merely 1.5% with post-graduate-equivalent and above qualifications (NSO 2021). Importantly, only 32.39% of the total persons with disabilities aged 10 years and above stated that they were usually economically active, of which a staggering 8.16% reported to be unemployed during the National Census in 2021 (NSO 2021). Rana et al. (2022) similarly flagged that the participation of persons with disabilities in employment is reduced as compared to the general population, increasing the likelihood of becoming financially dependent on the family. Also, a substantial gap in access to health services was reported by persons with disabilities in Nepal where 40% stated they did not receive health services when in need (Baral 2018; Eide et al. 2016). To address this situation of multiple disadvantages, the Nepalese Government has envisioned several interventions as part of its social security, one of which is social security allowances for persons with disabilities. Bhujel (2022) found a significant dependency of persons with disabilities on social security allowance provided by the government, with more than half of the respondents (n = 122) relying on it as their primary source of income, and underscored the need for continued government support and robust social protection policies.

In the context of a high prevalence of persons with disabilities in developing countries, including Nepal, multiple disadvantages highlighted by this population, and the need to address the significant gap in socio-economic conditions and experiences of well-being between persons with disabilities and those without them in the community, this paper describes the policies related to people with disabilities in Nepal, examines the practices, and highlights the paucity in policies and their translation into practice, particularly with regard to disability protection through allowances.

2. Materials and Methods

This study adopted a rapid review approach to explore the social security provisions of allowances for persons with disabilities in Nepal as a rapid review allowed mapping the existing literature and identifying key concepts, gaps, and the breadth of evidence surrounding social security policies and practices. The following subsections delineate the research design, search strategy, inclusion and exclusion criteria, data extraction and analysis, and ethical considerations. The methodology of this study was drafted using generative AI (Avidnote.com, accessed on 14 February 2025) for useful outlines and structures only.

2.1. Research Design

The rapid review methodology was selected to provide a comprehensive overview of the available evidence regarding social security allowances for persons with disabilities in Nepal. This approach was particularly valuable for this study since it enabled the identification of gaps in knowledge and the range of policies and practices in place. The rapid review approach was adopted for this paper to provide the required information for the swift development of a comprehensive grant and research project on disabilities and social security in Nepal. The review process included the following stages: identifying the research question, identifying the relevant literature, selecting the literature, and collating, summarizing, and reporting the results. The literature published between 2014 to 2024 to capture the discussions on policies and practices regarding social security provisions, particularly the disability allowances or cash transfers relating to persons with disabilities in Nepal, was included.

2.2. Inclusion and Exclusion Criteria

To ensure a focused and relevant selection of literature for the rapid review, specific inclusion and exclusion criteria were established, as given below. The application of these criteria resulted in a more manageable and relevant body of literature for analysis.

2.2.1. Inclusion Criteria

• Relevance to the Topic: publications addressing social security provisions for persons with disabilities in Nepal, including policies, practices, and empirical studies.
• Time Frame: studies published between 1 January 2014 and 31 December 2024.
• Language: publications available in English.
• Types of Literature: peer-reviewed articles, government reports, policy analyses, gray literature, and theses/dissertations.

2.2.2. Exclusion Criteria

• Irrelevance: publications not specifically addressing the topic of social security allowances for persons with disabilities in Nepal.
• Time Frame: studies published before 1 January 2014, and after 31 December 2024.
• Language: publications not available in English.
• Types of Literature: non-academic sources, opinion pieces, and articles lacking empirical evidence or policy analysis.

2.3. Search Strategy

A comprehensive search strategy was developed to identify the relevant publications related to social security provisions for persons with disabilities in Nepal. The search was conducted across multiple electronic databases, including PubMed, Scopus, Web of Science, Google Scholar, and the Nepal-specific database named Nepal Journals Online (NepJOL). The search strategy employed a combination of keywords and Boolean operators to optimize locating the relevant literature.

The search terms included “disability”, “Nepal”, “social security”, and “allowance”. The initial search yielded a substantial number of results. Using “disability” and “Nepal” yielded 481 results in PubMed. Adding (social security) yielded 10 results, which were downloaded. Using “disability” and “Nepal” yielded 15,687 documents in Scopus. Adding allowance reduced the results to 101. Nine articles were downloaded after screening the titles for relevance. A total of 715 documents were listed using “disability” and “Nepal” in the Web of Science database, and adding “allowance” zeroed the results to one article, which was downloaded. NepJOL displayed 37 items with the search word “disability”. A total of 11 articles were downloaded after screening the titles. Google Scholar listed 28,900 results with a search using “disability” + “Nepal” and excluding citations. Adding “allowance” reduced the results to 3030. Adding “social security” narrowed the results to 1240. Adding policy eliminated 20 entries to produce 1220 results. Sorting the results to include only review articles displayed 80 results.

The downloaded publications were further screened for their relevance to this study through reading of their abstracts. This resulted in the selection of seven articles from NepJOL, five from PubMed, four from Scopus, one from Web of Science, and twenty from Google Scholar. Publications that were in multiple databases were filtered to avoid redundancy. The reference list of the identified publications was reviewed to expand relevant studies. Several other documents and articles were consulted for providing the context of this study. The final review comprised of 32 entries.

2.4. Data Extraction and Analysis

Data extraction was carried out using a structured data charting form, which facilitated the systematic collection of key information from each selected publication. The data extraction process included the following components:

• Citation Information: author(s), year of publication, title, and source.
• Study Type: classification of the publication type (e.g., empirical study, policy document, review article).
• Key Findings: summary of the main findings relevant to social security allowances for persons with disabilities.
• Policy Context: description of the policy framework surrounding social security for persons with disabilities, including any legislative changes or government initiatives.
• Gaps and Recommendations: identification of gaps in the literature and recommendations for future research or policy improvements.

Analysis of the extracted data was conducted thematically, allowing for the identification of recurring themes, patterns, and discrepancies within the literature. The thematic analysis followed the six-phase process outlined by Braun and Clarke (2006): familiarization with the data, generating initial codes, searching for themes, reviewing themes, defining and naming themes, and producing the report. The themes identified in the analysis were categorized into three main areas: (1) policy frameworks; (2) practices—implementation of policies and challenges and barriers to access; and (3) paucity—identifying the gaps and/or areas for improvement.

2.5. Ethical Considerations

Although the rapid review methodology involved analyzing the extant literature and did not involve primary data collection from human participants, the processes of ethical research were upheld. The following ethical principles guided this study:

• Transparency: the research process was carried out transparently, with clear documentation of the methodologies employed and the rationale for decisions made throughout the rapid review.
• Integrity: this study adhered to the principles of academic integrity, ensuring that all sources were appropriately cited and credited.
• Respect for Local Context: given the focus on Nepal, this research was conducted with an awareness of the local socio-cultural context and the importance of respecting the rights and dignity of persons with disabilities.

Furthermore, the findings of this study aim to contribute to the ongoing discourse surrounding social security for persons with disabilities in Nepal, providing valuable insights for policymakers, practitioners, and researchers in the field.

2.6. Limitations of This Study

While the rapid review methodology provides a comprehensive overview of the literature between 2014 and 2024, we would like to acknowledge two limitations of this exercise. The first of these limitations relates to the exclusion of non-English publications, particularly Nepali, despite the study focusing on Nepal where Nepali is the predominantly used language in common parlance and official engagements. Delimiting the search to the literature published in English may have limited the breadth of perspectives included in this review. This English-language restriction was due to two of the authors lacking proficiency in Nepali, which would have made translation necessary and increased costs. The second limitation is the dynamic nature of policy changes in Nepal and therefore the exclusion of literature before 1 January 2014, and after 31 December 2024 may not have succinctly captured the dynamism of policy development in the country since the first policy, namely The Disabled Persons Protection and Welfare Act (DPWA), 1982. It should be noted that the goal of the study was to capture current (from the last decade) discussions on policies and practices related to the social security allowances for persons with disabilities in Nepal.

3. Findings

This review of literature on disabilities and social security in Nepal is presented in four sections—policies relating to persons with disabilities, the practices in the field, the gaps or paucity in policy implementation, and findings of the rapid review considering the ‘Joint Statement: Towards inclusive social protection systems supporting the full and effective participation of persons with disabilities’.

3.1. Policies for Persons with Disabilities in Nepal

The government of Nepal has made appreciable efforts to include social protection in its legislation, strengthening its commitments to improve the social protection system (Bloch 2020). Nepal has a relatively strong social protection system in Asia and the Pacific; it has made concerted efforts to be inclusive of people with disabilities, particularly through multiple disability-targeted programs and provides examples of good practice in disability-inclusive program design and implementation (Banks et al. 2019). Notably, the development of social security for persons with disabilities in Nepal was slow and gradual. The Disabled Persons Protection and Welfare Act, 1982, followed by the Social Welfare Act 1992 aimed at ensuring the welfare of the children, the elderly, and persons with disabilities. A series of legislations including the Education Act 1992, Child Rights Acts of 1992, and Local Self-Government Act 1999 facilitated the focus of policy on persons living with disabilities in the country (Baral 2018; UN 2018). In 1994, the Disabled Protection and Welfare Regulation was framed to implement the DPW Act (Banskota 2015; Timilsana 2018; UN 2018). Timilsana (2018) highlights that Local Self-Government Act 1999 reiterated the responsibility of the state to care for persons with disabilities by providing the local governments, including the Village Development Committees, with the authority to design activities to protect their rights and mandated them to maintain records of persons with disabilities. Khanal (2014) states that a cash transfer program initiated in 1995 for senior citizens above 75 years of age was the first of its kind in Nepal. Sijapati (2017) highlights that Nepal has implemented multiple protective measures for vulnerable groups, including cash transfers to people with disabilities since 2005. Thapaliya (2016) draws attention that the Tenth Five-Year Plan (2002–2007) aimed at providing equal rights and a barrier-free environment for the development of persons with disabilities, including the development of prevention and rehabilitation centers, facilitating access to education and sports-related activities. In 2008, Nepal signed the Convention on the Rights of Persons with Disabilities and the Optional Protocol to the Convention on the Rights of Persons with Disabilities and ratified them in 2009 (Banskota 2015; Baral 2018). To harmonize its commitment to these international agreements, through a Constituent Assembly, the government of Nepal drafted the 2015 constitution, which promulgated that there shall be no discrimination in the application of general laws on the grounds of physical conditions, health conditions, and physical impairment/conditions (Banskota 2015; Baral 2018; Thapaliya 2016).

Table 1. Legislations relating to persons with disabilities in Nepal and their outlined provisions.

Legislations	Focus/Provisions
The Disabled Persons Protection and Welfare Act, 1982	Primary legislation that aimed at ensuring the welfare of the children, the elderly, and persons with disabilities
Local Self-Government Act 1999	Provided local governments, including the Village Development Committees, the authority to design activities to protect the rights of PWDs and mandated these bodies to maintain records of persons with disabilities
Tenth Five-Year Plan (2002–2007)	Development of prevention and rehabilitation centers, facilitating access to education and sports-related activities
The 2015 constitution	Promulgated that there shall be no discrimination in the application of general laws on the grounds of physical conditions, health conditions, and physical impairment/conditions
The Act Relating to Rights of Persons with Disabilities 2017	Free education, free medical examination in all state hospitals; prioritization at employment in government and semi-government institutions and ensuring non-crimination in remuneration, facilities, and service conditions; providing a loan of 5k–20k without collateral for skills-based self-employment; and free legal aid to persons with disabilities; reservation of 5% of total seats in TVET programs in each government and semi-government institution without any costs; reservation of at least two free beds—in any hospital with more than 50 beds—for the treatment of persons with disabilities

lists all the important legislations relating to persons with disabilities in Nepal and their focus or key provisions.

3.2. Practices Relating to Disability Allowance

There is a difference between the perception of persons with disabilities by the state and by families in Nepal. From the earlier section of this paper, it is evident that the state is geared towards ensuring a safe space for persons with disabilities and making sure they are not discriminated based on their ability or lack thereof. However, many families with persons with disabilities are yet to internalize this perspective. A disability in Nepal is often seen a punishment, an effect of karma, for an individual’s sinful actions in their past lives (Banskota 2015; Thapaliya 2016). This perception of disability among the general population has an impact on the social presence and interactions of persons with disabilities and ultimately affects their access to services. Persons with disabilities are also disproportionately affected by natural disasters as they “often lack the resources to evacuate threatened areas and typically live in low-cost, low-quality housing that is more prone to damage or collapse” (Peek and Stough 2010 in Holmes et al. 2018, p. 2), and this is an important policy consideration in the context of Nepal’s vulnerability to natural disasters like earthquake, floods, and landslides.

Thapaliya (2016) analyzed policies, acts, and regulations in Nepal relating to persons with disabilities to locate nine key areas of government interventions. These interventions related to persons with disabilities are the offering of color-coded identity cards for persons with disabilities; free education and provisions for the use of assistants during examinations for visually impaired persons; ensuring scholarships for vocational and technical training; free medical examination for all and free medical treatment for those above the age of 65 in government hospitals; reservation of 5% of all civil service jobs; 50% discount on public transportation and the reservation of seats in vehicles with a seat capacity of 15 or more; calling for accessible public buildings and places; exemption of income tax and custom-free means of transportation; and provision of social welfare allowances, including disability allowances. Banks et al. (2019) similarly identified five disability-targeted social protection entitlements in Nepal: disability allowance, health discounts, education support, vocational training and employment opportunity, and transportation discounts.

Holmes et al. (2018) state that a disability allowance is one of five government-run social security allowance schemes in Nepal that provides cash transfers to people with disabilities. Social security allowances have been an important part of the income of persons with disabilities in Nepal, helping them improve their living standards, although the amounts have been marginal (Wagle 2015). The disability allowance has also been found to be a significant support for the family, not just the individual receiving it. Holmes et al. (2018) found that, when children with disabilities received a disability allowance, some families used it to fulfill the immediate and basic needs of the child related to food, clothing, health, and education, and many families saved it for the future needs of the child. However, Bhujel (2022) found that many of the people with disabilities receiving cash assistance indicated that it was inadequate and only covered less than 25% of their expenses. Banks et al. (2019) flagged that the disability allowance was unlikely to cover the expenses that people with disabilities and their households incur, including disability-related costs, loss of income from household members’ engagement in caregiving roles, and exclusion of people with disabilities from work, and suggested improving the quality and availability of linked services and increasing the value of the cash transfers to improve the impact of these programs and to encourage greater enrolment.

Importantly, people with disabilities must first obtain a disability card to be eligible for social security entitlements. Based on an application that includes the self-reported type and severity of disability, followed by in-person evaluation by a Disability Identification Committee, an applicant is classified into one of four disability card categories (Banks et al. 2019). The Ministry of Women Children and Social Welfare (MoWCSW) assigned various colored cards to persons with different categories of disabilities, viz. red for persons with complete disability, blue for severe disability, yellow for moderate disability, and white for mild disability (UN 2018). Notably, the disability allowance is reserved for people with the two card categories for the most severe disabilities (red and blue) (Banks et al. 2019). According to National Federation of the Disabled-Nepal (NFDN), persons with complete disability receive a monthly allowance of NPR 1000 and persons with partial disability receive a monthly allowance of NPR 600 (NFDN 2018), and the allowance is transferred through the bank or hand-delivered every four months (Holmes et al. 2018).

However, several barriers to accessing disability identification cards exist including a lack of knowledge of its existence and required documentation, a lack of information on the location and process of application, and challenges associated with the assessment (Holmes et al. 2018). Holmes et al. (2018) also draw attention to the fact that the disability allowance was scaled up as an emergency cash response to the earthquakes of 2015, but problems were reported in accessing the scheme during the earthquake, and the current high exclusion errors limit the potential of using the scheme to respond to future shocks.

The presence of persons with disabilities in a family notably affects their functioning. Eide et al. (2016) found that households with at least one person with a disability as a member scored lower on most indicators of the level of living than control HHs, where the indicators comprised possessions in the household, dietary diversity, access to information, and dependency ratio. They also found the control households to be somewhat better off than households with persons with disabilities in relation to infrastructure (housing facilities, type of houses, access to water, toilet facilities) and ownership of houses, and these differences were more pronounced for rural areas than urban areas (Eide et al. 2016). Holmes et al. (2018)’s finding may explain some of these differences that Eide et al. (2016) found, for example, the added expenditure on health care, along with specialized care and assistive devices, limited the economic activity of parents due to increased caregiver responsibilities.

Eide et al. (2016) also found differences in the gendered experiences of disabilities in Nepal, where, on the one hand, females with disabilities had significantly lower school attendance, lower level of literacy, less involvement in working life, and more limited access to assistive devices, and they reported lower levels of participation, whereas, on the other hand, fewer females reported having chronic illnesses, experiencing discrimination by public services, or a refusal of school entry, and they reported spending more years in school as compared to their male counterparts. Holmes et al. (2018) found that many children with disabilities, particularly in rural areas, had dropped out of non-specialized schools due to their disability—inadequate infrastructure and facilities to support them, difficulty in studying, concentrating, and keeping up with the class, and punishments from teachers for underperforming along with bullying by peers and exclusion in play-related activities.

3.3. Gaps in Policy Implementation

Sapkota (2024) underscored that the status of policy implementation was not satisfactory and pointed out that there is ample room for improvements. Acharya (2022) highlighted considerable variations in access to social security across provinces and ecological regions; based on the 2017–2018 Labour Force Survey data, the percentage of households reporting access to at least one type of social security ranged from 4.5 percent in Sudurpashchim to 41 percent in Province Three, whereas five percent of mountain households reported having access to social security compared to 50 percent in the hills and 45 percent in the Terai.

Baral (2018) highlighted that, although Nepal has adequate policies targeted at persons with disabilities, their implementation is undermined by the lack of responsibility, accountability, and transparency. Baral’s claim finds evidence in the accessibility audit of public infrastructure conducted by The National Federation of the Disabled-Nepal (NFDN) in 2018 to a follow up of the Accessible Physical Infrastructure and Communication Services Directive for People with Disability 2013, a key legal measure taken by the government for promoting accessibility. In their audit of 150 sample public infrastructure, NFDN (2018) found none of the samples to be fully accessible in line with the government standards, only 18 samples to be partially accessible, and a majority (132 samples) to be inaccessible. This study conducted 5 years after the directive illuminates the unpreparedness of the state in implementing its own policies. National Planning Commission (NPC 2012) in its Assessment of Social Security Allowance Programs in Nepal found a lack of clarity in policies regarding social security programs; reliance on few human resources to manage huge budgets; a lack of enthusiasm on part of local bodies towards program implementation due to administrative budgetary constraints, weak inter-agency coordination, and insufficient monitoring and evaluation. There is evidence, including anecdotal, that illuminates state’s failure to uphold Disability Rights Act 2017, which prohibits violence against persons with disabilities. About 58% of women with disabilities stated experiencing violence, which included emotional (55%), physical (34%), and sexual (22%) violence (CREPHA 2011 in UN 2018). Eide et al. (2016) found that 24% of the respondents who experienced violence claimed that such experiences were because of their disabilities.

The slack in policy implementation is also clearly seen in service delivery. In the context of disability and social security in Nepal, a high number of people living with disability (83%) in Nepal do not have a disability card (Eide et al. 2016; Holmes et al. 2018). However, the UN (2018) expresses that the Ministry of Women, Children and Social Welfare has distributed identity cards to about 40% of all persons with disabilities in Nepal. Holmes et al. (2018) speculate that the low participation of persons with disabilities in obtaining identity cards may be from choice (e.g., people voluntarily not applying for a disability card because of stigma) or because they face barriers in accessing the card.

Banks et al. (2019) found that enrolling in disability-targeted schemes was challenging for eligible individuals as it required travelling to the district headquarters as part of the application process, which may be particularly onerous for people with disabilities. Banks et al. (2017) underscored that meeting the financial costs of travel might add another layer of challenge to people with disabilities as they are more likely to be living in poverty. They also identified the lack of accessible transportation to be disadvantageous to people with mobility limitations and/or living in remote areas.

Bhujel’s (2022) analysis of socio-economic conditions of people with disabilities showed no significant association between the type of identity card (red or blue) and factors such as house ownership, equity quintile, or main source of income, suggesting that the issuance of the cards is not influenced by these socio-economic factors. However, Holmes et al. (2018) found that having a severe physical disability and for a longer time, being male, being of a working age, being literate, living in a rural area, having a less diverse diet, living with a female household head, and being aware of health services to be associated with a higher probability of receiving a disability card.

Barriers in accessing a disability allowance could be attributed to a lack of information about the disability card or allowance, a lack of information on the procedure for applying and obtaining the card, not being able to apply from the place of usual residence, a lack of information about the assessment of disabilities and concerns of corrupt practices, a lack of information on the necessity to submit documentation for the allowance after receiving the disability card, and the absence of a system providing benefits automatically after the disability card is made (Holmes et al. 2018). Additionally, having to queue up for a long time to collect payments and having a fixed date for collecting payments of allowances were also reported as challenges in accessing disability allowances (Holmes et al. 2018). Baral (2018) highlights that a large proportion of persons with disabilities have to access many of the services and that the available services are also not enough to cater to their needs. These barriers are similar to the ones identified by Gooding and Marriot (2009) who found limited awareness among recipients, complex and unaccountable administrative systems, physically inaccessible or unavailable services, and conditions attached to the limited access of persons with disabilities to cash transfer programs in developing countries. This knowledge can be used by policymakers and practitioners to fill the gap between those who are entitled to receive the state-provided benefits and those who receive them.

Another paucity regarding persons with disabilities in the country is the inadequate data on the extent of disabilities and the various dimensions of the lives of persons with disabilities in Nepal. Disability statistics is confusing and complicated due to frequent changes in definitions of disability in terms of screening for disability, services related to disability, and the extent to which conditions are disabling (UN 2018). The lack of standardized statistics on disability prevalence in Nepal means there are knowledge gaps (Holmes et al. 2018). The lack of information on the provisions available for persons with disabilities and how to access these provisions was ubiquitously mentioned (Baral 2018; Eide et al. 2016; Holmes et al. 2018). Data regarding the status of employment for persons with disabilities in Nepal are insufficient and come merely from sporadic surveys (UN 2018). Women and children disproportionately face violence and abuse due to disabilities, based on anecdotal evidence, but there is limited information in this area (UN 2018). Evaluation research is also important to understand the impact of social security provisions including disability allowances on the lives of persons with disabilities, and this is an overlooked area in Nepal. Khanal (2014) claimed that no comprehensive evaluations of social security allowances have been carried out, except for few studies using primary data. The literature on persons with disabilities and social security in Nepal insufficiently brings out the overall experiences of persons with disabilities including their experiences within families, interactions with the state mechanism, and the challenges and opportunities associated with their identified disability status. The extant literature has not adequately thrown light on the experiences, including struggles and achievements, of organizations that are working with persons with disabilities or are led by them.

An overarching paucity of social protection in Nepal is that only about 2.3 million Nepali citizens, i.e., less than 10% of its population, receive any form of social protection transfers, and it leaves the power relations and wealth distribution intact; hence, social security programs remain populist despite a welcome and much needed response from the government (Koehler 2014). The management of cash transfers has also raised issues including inefficiency in the delivery of services and the mismanagement and even misappropriation of funds (Khanal 2018; NPC 2012). Banks et al. (2019), in their mixed methods study of a district in Nepal, found that less than one-third of people with disabilities had a disability card, and only 13.4% were receiving the disability allowance. Earlier, Holmes et al. (2018) suggested that the gap between the number of people receiving a disability card and the number of people receiving disability allowances in Nepal to be between 30% and 60%, and Eide et al. (2016) projected this gap to be 58%. This finding is important considering The World Bank’s (2013) report that social assistance programs (cash transfers) in Nepal leave a large population below the poverty line while benefiting a significant fraction of the non-poor. This situation could mean that the percentage of people with disabilities that are the intended and needy recipients of the disability allowance who are getting these allowances is even smaller than what the data projects. Furthermore, the breadth of projection highlights the need for stronger data management on the part of the Government of Nepal, who is ultimately the guardian of all its citizens.

The World Bank further highlights that such programs need to be specifically targeted to the needy and better coordinated to reduce leakage of funds and minimize overlapping of beneficiaries across programs (The World Bank 2013). Drucza (2015) similarly contends that the existing social protection mechanism and services in Nepal do little to ameliorate the uneven development due to the exclusion prevalent for centuries. These gaps between policies and practices, prevalent barriers to accessing prevalent services, the dearth of research on social security, and its impacts on persons living with disabilities provide avenues for future research.

3.4. Findings of the Rapid Review Considering the Joint Statement

The International Labour Organization and International Disability Alliance 2019 is concerned about promoting inclusive social protection systems for persons with disabilities. The statement emerged through discussions among international partners working on the issues of disability and social protection and provides a notable vantage point for reflection as well as guidance towards ensuring inclusive social protection systems for persons with disabilities. This section of the paper evaluates the findings of the rapid review in light of the Joint Statement.

Nepal’s efforts towards instituting a robust social protection system and the inclusion of people with disabilities has been lauded (see Banks et al. 2019; Thapaliya 2016; Sijapati 2017), highlighting the multiple disability-targeted programs that demonstrate disability-inclusive design and implementation (Banks et al. 2019), cash transfers to people with disabilities (Sijapati 2017), the focus of the Tenth Five-Year Plan (2002–2007) on equal rights, a barrier-free environment for the development of persons with disabilities (Thapaliya 2016), and a commitment to upholding the Convention on the Rights of Persons with Disabilities and the Optional Protocol through the 2015 constitution (Banskota 2015). However, Nepal still has a long way to go for it to move away from the disability as the incapacity to work perspective and, therefore, the need to protect people with disabilities. Much of the legislations relating to people with disabilities (namely The Disabled Persons Protection and Welfare Act 1982, Social Welfare Act 1992, The Disabled Protection and Welfare Regulation 1994, and Local Self-Government Act 1999) seem to be guided by this approach. A key issue with this approach is the viewing of disability as an individual problem and ignoring the negative impact of social barriers and attitudes on persons with disabilities and on their economic participation and overlooking the capacity of persons with disabilities to actively contribute to society (International Labour Organization and International Disability Alliance 2019). The Joint Statement invites all stakeholders to rethink the social protection systems considering the Convention on the Rights of Persons with Disabilities (CRPD), calling for an enabling approach to acknowledge the capacities of persons with disabilities and promote their economic participation by addressing the barriers they face and extending relevant disability-related support, and the findings of the rapid review illuminates the ample scope of work in this area.

The Joint Statement highlights the following considerations as the key to ensuring access and strengthening the effectiveness of the programs relating to persons with disabilities, namely non-discrimination and accessibility, respect for dignity, personal autonomy, choice, control over one’s life and privacy, full and effective participation and inclusion, consultation and involvement of persons with disabilities, attitudes and awareness, adequacy of benefits and support, eligibility criteria and disability assessments, and monitoring and evaluation, and we further reflect on the findings of the rapid review in light of these considerations.

Many children with disabilities in Nepal, particularly in rural areas, did not have equal access to educational facilities, experienced inadequate support from teachers, and faced discrimination in the forms of bullying by peers and exclusion in play-related activities (Holmes et al. 2018). Persons with disabilities in Nepal have been found to suffer from violence, e.g., 58% of women with disabilities stated experiencing violence which included emotional (55%), physical (34%), and sexual (22%) violence (CREPHA 2011 in UN 2018) and 24% of the respondents experiencing violence pointed to their disabilities as the cause of violence (Eide et al. 2016).

Inequitable access to social security provisions were noted across provinces (4.5 percent in Sudurpashchim to 41 percent in Province Three) and ecological regions (five percent in mountain households to 50 percent in the hills) in Nepal (Acharya 2022). Eide et al.’s (2016) finding that households without a person with a disability scored better than those with a person with a disability on most indicators of the level of living and in relation to infrastructure (housing facilities, type of houses, access to water, toilet facilities) and ownership of houses resonates with the context in which the Joint Statement emerged. Mitra et al. (2017) similarly found substantial extra costs associated with disabilities, which in turn were linked with the economic disadvantage of persons with disabilities and families with a person with a disability. Also, the disproportionate effects of natural disasters were noted on persons with disabilities in Nepal because of inadequate resources to evacuate threatened areas and likelihood to be living in low-cost, low-quality housing prone to damage or collapse (Peek and Stough 2010 in Holmes et al. 2018). Furthermore, Eide et al. (2016) found that households incurred added expenditure on health care along with specialized care and assistive devices, and economic participation of household members was limited due to increased caregiver responsibilities aligned with the call made through the Joint Statement to ensure the coverage of disability-related costs and facilitate access to the required support, including services and assistive devices towards building inclusive social protection systems.

In terms of benefits and support for persons with disabilities, some government interventions were notable, e.g., disability allowances, health discounts, education support, vocational training and employment opportunity, and transportation discounts (Banks et al. 2019; Thapaliya 2016). The disability allowance was noted as a significant support to individuals receiving it (Wagle 2015), as well as their families (Holmes et al. 2018). However, the support has not been adequate (Banks et al. 2019; Bhujel 2022; Wagle 2015). Banks et al.’s (2019) research underscored that the disability allowance was unlikely to cover the expenses that people with disabilities and their households incur, including disability-related costs, loss of income from household members’ engagement in caregiving roles, and exclusion of people with disabilities from work. Another important finding of the rapid review relates to the challenges faced by people with disabilities in obtaining a disability card, which is mandatory for social security entitlements. Several authors have noted that most people living with a disability in Nepal do not possess a disability card (Eide et al. 2016; Holmes et al. 2018). Although the Ministry of Women, Children and Social Welfare claims to have distributed identity cards to about 40% of all persons with disabilities in Nepal (UN 2018), it still shows that a significant population who should receive the disability allowances are yet to receive them. A lack of information about the disability card or allowance, a lack of information on the procedure for applying and obtaining the card, not being able to apply from the place of usual residence, a lack of information about assessment of disability and concerns of corrupt practices, a lack of information on the necessity to submit documentation for the allowance after the receiving the disability card, and the absence of a system providing benefits automatically after the disability card is made were notable in this regard (Holmes et al. 2018). Furthermore, persons with disabilities faced several barriers in accessing the card (Holmes et al. 2018), including challenges associated with travelling to the district headquarters as part of the application process (Banks et al. 2019), specifically meeting the financial costs of travel and availability of accessible transportation (Banks et al. 2017).

Significant knowledge gaps relating to persons with disabilities in Nepal were illuminated by the rapid review including the lack of standardized statistics on disability prevalence (Holmes et al. 2018), the unavailability of reliable data regarding the status of employment for persons with disabilities, and a general lack of information on the provisions available for persons with disabilities and the process of accessing them (Baral 2018; Eide et al. 2016; Holmes et al. 2018). Perhaps the most important finding is that the implementation of policies targeted at persons with disabilities exhibits a lack of responsibility, accountability, and transparency (Baral 2018) and a lack of clarity about policies regarding social security programs; reliance on few human resources to manage huge budgets; a lack of enthusiasm on part of local bodies towards program implementation due to administrative budgetary constraints, weak inter-agency coordination, and insufficient monitoring and evaluation (NPC 2012).

4. Conclusions and Recommendations

Nepal has always been quick to express its commitment to international instruments including the United Nations Convention on the Rights of Persons with Disabilities (UNCRPD). The UNCRPD and its optional protocol were adopted on 13 December 2006, and Nepal ratified both the UNCRPD and optional protocol on 7 May 2010 (CIL n.d.). But upholding the convention has proven to be a challenge for Nepal as several gaps between policies and practices have been identified. Banks et al. (2019) illuminate that, in its current state, social protection in Nepal will be insufficient in meeting its intended goals among recipients with disabilities, particularly in promoting stronger livelihoods and social inclusion. Several gaps between policies and practices relating to people with disabilities in Nepal were underscored through this study.

Reflecting on the findings of the rapid review considering the Join Statement on Inclusive Social Protection underscored that, despite Nepal’s expressed commitment towards the inclusion and participation of persons with disabilities through social protection systems, persons with disabilities are yet to experience adequate inclusion and continue to face a myriad of challenges in their everyday lives, including discrimination and violence, unequal access to education and health, disproportionate brunt of natural disaster, additional disability-related costs, and difficulties in accessing the disability identity card and the facilities that come with it (including disability allowance). The next section outlines the recommendations made towards reducing the gap between policy and practice relating to disability protection in Nepal through allowances identified through the rapid review.

Recommendations

A key recommendation for the way ahead is to improve data collection and analysis systems for ensuring data accuracy and expansion of research activities (Banskota 2015; Holmes et al. 2018; UN 2018). Khanal’s (2013) suggestion for strengthening social protection mechanisms with adequate legwork and preparation and being guided by well-crafted policy rather than a piecemeal approach could be useful for policy implementation regarding persons with disabilities too. Banskota (2015) in his review of disability policies in Nepal argued that the commitment to persons with disabilities as expressed through policies should be augmented with budget allocation for effective materialization and better monitoring and evaluation.

Eide et al. (2016) stresses the need to reduce the differences in the levels of living for persons with disabilities and those without them and draws attention to the need for a multi-sector strategy. Through a systematic review, Mitra et al. (2017) found significant and heterogenous costs of disabilities globally, and they called for quantifying the extra costs of disabilities so that policymakers in each country can allocate sufficient resources to provide the necessary disability support services. Responding to Mitra et al.’s (2017) call seems imperative for disability protection in Nepal through allowances in the light of the findings of the rapid review that people with disabilities in Nepal are disproportionately disadvantaged economically. It is noteworthy that addressing the extra costs of disability is important to facilitate the economic participation of persons with disabilities. Holmes et al. (2018) is concerned about the exclusion of persons with disabilities from obtaining the disability card and associated allowances and suggests measures to effectively communicate about the disability card, the associated allowance, and assessment guidelines for raising awareness among the masses to include them in the social security net. Holmes et al. (2018) additionally suggest developing a grievance redressal mechanism, automatically enrolling red and blue card holders to receive the allowance, ensuring beneficiaries are able to apply for the disability allowance where they are currently residing, ensuring that infrastructure and services for delivering the allowance are accessible to people with disabilities, and coordinating and linking with other relevant programs and services to better address the needs of persons with disabilities in Nepal. Banks et al. (2019) recommend aligning program benefits to meet the needs of people with disabilities, increasing the awareness of cash and non-cash benefits, including eligibility requirements and application procedures, carrying out the eligibility assessment effectively, and facilitating the application procedures as pivotal in including people with disabilities in the programs for which they are eligible.

UN (2018) suggests that the way forward for Nepal is to give continuity of legislative changes to make legal provisions inclusive, strengthen the extant community-based rehabilitation programs present at the district level, continue providing allowance for disability card holders, and to integrate innovation and technology for ameliorating the difficulties that persons with disabilities face in their day to day lives. Khanal (2013) contends that institutions and service delivery should be transparent, accountable, and efficient; coherence in policy and institutions need to be ensured; piecemeal programs should not be entertained; duplication and shifting of responsibilities and accountabilities should be avoided; and local stakeholders should be involved in both policy formulation and implementation.

To sum up, this rapid review on the social security provisions of allowances for persons with disabilities in Nepal illuminates the policies, practices, and the paucity in the field through a review of literature published in the last decade. The findings have the potential to contribute to a deeper understanding of the challenges and opportunities within the social security landscape for persons with disabilities in Nepal. The findings are thus useful for practitioners and policymakers concerned with persons with disabilities in Nepal and are helpful in offering insights to enhance the rights and well-being of this marginalized population.