Disability Certification in Colombia: An Analysis from the Perspective of Inclusive Social Protection

Abstract

Disability Certification is an instrument that can contribute to the identification of persons with disabilities who are potential beneficiaries of social protection programmes. In Colombia, the disability certification process was changed in 2020 to include a human rights perspective. However, little information exists on how far the process aligns with the recommendations made by the Convention on the Rights of Persons with Disabilities or to what extent it provides useful information for the operation of the country’s social protection system. This study aims to analyse how the changes implemented in 2020 have contributed to the identification and determination of persons with disabilities in social protection programmes in Colombia. This research uses an analytical-descriptive design, in which legal documents related to the social protection programme and disability certification were analysed. In addition, we conducted semi-structured interviews in Colombia with people with disabilities, professionals conducting the certification, and with key stakeholders, and we analysed the information using thematic analysis. Colombia changed its certification process in 2020, moving from a capacity-to-work assessment to a process of assessing functioning capacity and participation limitations following the International Classification of Functional Disability and Health. However, the new certification process has not provided an instrument to contribute to determining persons with disabilities who should be prioritised or receive social benefits in Colombia. The certification does not establish the support needs of people with disabilities, does not recommend reasonable adjustments to support their participation in society, and has not been used systematically in social protection programmes. Finally, individuals with disabilities commented that the disability certification is a process that does not open up opportunities to receive social benefits and social transfers, and in most cases, it is an expensive and lengthy process. Disability certification in Colombia is not an instrument that determines the needs of people with disabilities, nor the reasonable accommodations that they require in order to participate in society.

1. Introduction

The term “social protection” refers to the various policies and programmes that governments, international organisations, and other entities implement to provide support and/or assistance to individuals and families who are vulnerable or disadvantaged [1]. Such programmes may include a variety of measures, such as cash transfers, food assistance, health care, and education. In recent years, the discussion concerning the provision of universal social protection systems has developed, aiming to adopt a gender and life-cycle approach, which also covers context-specific risks, such as those related to climate or the natural environment, as well as other risks, such as disability, that increase the likelihood of vulnerable individuals falling into poverty [2].

According to the United Nations (UN) Convention on the Rights of Persons with Disabilities (CRPD), a person with disability is one with a long-term impairment which interacts with different barriers that limit their full and effective participation in society on an equal basis. This definition recognises the importance of the interaction of a health condition or impairment with the barriers that exist in society and the need to guarantee that people with disabilities can participate on an equal basis in society. Article 28 in the Convention also mentions the need to guarantee an adequate standard of living for persons with disabilities and to ensure that this group can have access to social protection and poverty reduction programmes [3].

The study of social protection systems from an inclusive perspective identifies the need to guarantee that individuals, regardless of their gender, age, ethnic group, migratory status, or disability status, can be included within social protection programmes on equal terms [4]. This aligns with the need to guarantee the right to social protection for persons with disabilities. Therefore, barriers to accessing social protection programmes should be eliminated to guarantee these groups’ equal inclusion. For example, information regarding programmes must be presented in accessible formats and must be published in a variety of ways in order to ensure that people from different groups can access it in a timely manner [5].

In the case of people with disabilities, it has been identified that they face particular barriers in their efforts to access social protection systems: barriers such as stigma, physical inaccessibility, lack of reasonable adjustments, and inaccessible information, among others [6,7]. Therefore, it has been proposed that inclusive social protection programmes must be flexible and adaptable to the changing needs and circumstances of people with disabilities [4]. Among those proposals, the importance of including people with disabilities in the design of social protection programmes has been highlighted; to ensure their access to information and services, buildings, transportation systems, equipment, and devices may need to be adapted to meet their specific needs. Finally, the need to promote financial accessibility for people with disabilities in social protection programmes and the adaptation of the programmes to the particular contexts of this population is established [6,7].

In Latin America and the Caribbean, it is estimated that 85 million people live with disabilities [8]. Of this population, a large percentage faces high levels of poverty. Indeed, one in five households that include a member with disabilities is classified as extremely poor or living below the official poverty line of 3.2 USD/day; almost seven in 10 households with members with disabilities are vulnerable to falling into poverty [8].

Studies analysing the access of people with disabilities to social protection systems in Latin America and the Caribbean are limited. Most aim to identify how countries have established disability benefits and pensions [9]. Others have analysed whether disability and social protection legislation in the region have common objectives, and whether the lack of alignment is a barrier against the inclusion of people with disabilities, and most importantly, whether, in some countries, people with disabilities who are beneficiaries of social protection programmes are usually excluded from the labour market [10].

Social protection systems may include specific programmes for people with disabilities or aim to include this group as potential beneficiaries in mainstream programmes. In both cases, it is essential to identify who a person with a disability is and which additional needs he/she require to be met. This information will enable social programmes to prioritise those needs for assistance and support. To be able to know who has a disability, it is necessary to have a process that assesses the level and type of disability of the person in question and one which also identifies their particular needs for support. A disability certification may have several objectives, including identifying persons with disabilities, the type and severity of their disabilities, and their support needs. A disability assessment can also provide information for case management, referral, and policy design [11]. Therefore, the process of disability certification becomes a fundamental tool for the identification and targeting of beneficiaries of social protection systems.

Social protection programmes have positive effects, increasing the human capital of individuals and households, especially children [12]. Also, evidence shows that social protection positively affects poverty reduction [13] and increases consumption, which improves the quality of and access to health and education services, among other factors [14]. Although the importance for people with disabilities of social protection programmes with a universal approach has been recognised [6], only a few countries in Latin America and the Caribbean have implemented specific programmes for the population with disabilities (for example, Costa Rica, Ecuador, and Peru) [15]. The low number of programmes specific to the needs of persons with disabilities is usually associated with the lack of evidence of the extra costs incurred by their disabilities, as well as the difficulties of identifying persons with disabilities [16]. Therefore, the process of certification becomes a fundamental factor that makes it possible to collect information on the characteristics of people with disabilities, the type and severity of their disabilities, their support needs, and reasonable adjustments designed to improve their quality of life.

In the last few years, the process of certification has moved from an assessment and evaluation of the capacity to work to an assessment to understand the limitations in activities and restrictions on the participation of individuals. These changes in the process of conducting the certification of disability respond to the need to identify who a person with disability is and to conduct a needs assessment [11]. Different countries around the world have established changes in their certification process, aiming to follow a human rights approach and to include aspects related to participation and the barriers that people with different types of disability face, recognising the importance of the environment in the creation of disability. In Latin America, countries such as Panama and Peru have established certification processes that respond to this perspective of disability from a human rights perspective. However, a large number of countries continue to use the certification of disability as a process to determine if a person lives with disability and if this condition limits his/her ability to work, rather than aiming to understand the barriers that confront this group, and providing valuable information regarding their needs.

The social protection system in Colombia assists workers in the formal labour market (contributory regimen) and people who are categorised as poor according to a Proxy Mean Test (SISBEN) (social assistance programmes). The contributory regimen has a disability pension for persons with disabilities who have contributed to the system for a minimum of weeks and have also lost working capacity. No specific programme has been designed to support persons with disabilities in the country. Currently, a cash transfer programme has included as a priority group persons with disabilities with high levels of dependency, but to date, there is no evidence on how many people have been included (for more details, see [17]). In Colombia, until 2019, the registration of people with disabilities in the social protection system was related to the assessment of their capacity to work [17]. In 2020, new legislation aiming to improve the process of identifying persons with disabilities was implemented; the objective of this change was to move from a capacity-to-work assessment to a disability assessment by means of which the limitations on their participation in society and the restrictions on their activities were evaluated. The process requires that the person first requires his/her medical records and a doctors certification with his/her diagnosis, then the person will request an appointment to be evaluated, and during this appointment, a multidisciplinary team assess his/her condition using WHODAS-2 as the main tool, individuals who are identified as a person with disability will be registered in the Registro de Localización y Caracterización de las Personas con Discapacidad (RLCPD) [17].

The implementation of the new certification process has been limited, and by 2024, almost 150,000 people have been assessed, a number that is far from the expected number of persons with disabilities in the country; according to national statistics, around 2.5 million people in Colombia live with a disability [18]. Although the changes implemented aimed to improve the certification process for persons with disabilities, until now, it is unknown how the disability certification process aligns with the social protection system and whether the information generated by this tool is used to prioritise persons with disabilities in social protection programmes. Thus, this article aims to understand whether disability certification has (or has not) become a tool in the social protection system in Colombia, and to assess how it is used in the seven stages of the social protection delivery chain.

2. Materials and Methods

This article uses a qualitative hermeneutic phenomenological design. The research methodology follows an analytical-descriptive approach, which studies how the disability certification process in Colombia aligns with the implementation processes of a social protection system. Thus, this research uses two qualitative methods. The first consists of an analysis of the content of disability legislation that regulates the certification process. The second is a thematic analysis of semi-structured interviews with people with disabilities, with certifiers, and with policymakers who work to implement social protection programmes that include people with disabilities in the country.

We used the seven stages in the social protection delivery chain identified by Lindert et al. (2022) as a theoretical framework to define the categories and codes of the analysis [19]. The first stage is outreach to the intended population, who are potential beneficiaries of social protection programmes. The second stage is the intake and registration of the population. The third is the assessment of the needs and conditions of those who have already been registered in the system. The fourth stage is the eligibility assessment and enrolment of the individual concerned; then comes the determination of the appropriate benefits and service package (stage five); and then the notification provided to beneficiaries and the provision of services to them (stages six and seven).

2.1. Documentary Analysis

Aiming to understand how the process of certification has changed over time and has included aspects related to social protection, we selected documents in one of the following areas: (a) national regulations on aspects of disability certification, (b) national regulations on aspects of disability, and (c) national regulations on social security. After identifying documents in these areas, we read their content and identified secondary documents that provide information regarding the certification process and its possible relationship with social protection.

Table 1. Primary and secondary documents included in the analysis.

Primary Documents	Secondary Documents
Circular 009 2017 Resolution 113 2020 Disability Statutory Act 1618 Resolution 583 of 2018 Resolution 246 of 2019 Circular 048 of 2021 Resolution 1239 of 2022	Act 1346 of 2009 Act 361 of 1997 Act 100 of 1993 Social Protection Act 789 of 2002 Conpes Social 116 of 2013 National Public Policy on Disability (2013–2022) Act 1752 of 2015 Ombudsman Report 19. Situation of the rights of people with disabilities

lists the primary and secondary documents included in the analysis. Once documents were selected, a thematic analysis was conducted seeking to understand the disability certification procedure by analysing and evidencing its regulatory evolution. Likewise, it aims to identify the role of certification in the different processes of design and implementation of social protection programmes; to discuss what are, in accordance with the law, the potential benefits to which people with disabilities have access once the certificate is obtained; and, finally, to understand how the certificate is an instrument for the social inclusion of people with disabilities in Colombia.

2.2. Semi-Structured Interviews

Information was collected from nine participants, who included policymakers, disability certifiers, and people with disabilities and their caregivers (

Table 2. Main subjects interviewed.

Type of Interview	Number of People
Academic expert	1
Policy maker	4
Individuals implementing the certification	2
Person with disability or family member	2

). The objective was to understand, from their personal experiences, what the advantages, disadvantages, and “bottlenecks” are, and to formulate possible recommendations for the improvement of the national certification processes.

The inclusion criteria of participants were individuals 19 years or older, people with disabilities who had a disability certification, people who were engaged in the certification process or members of the Ministry of Health and Social Protection, and who were leading the certification process. An open invitation was sent to organisations of people with disabilities and families of people with disabilities to discuss the process of certification. We used a non-probabilistic snowball sampling. For this, a list of key interviewees was compiled, and immediately afterwards, these individuals were contacted and asked to suggest new contacts who could be informed.

We designed semi-structured interview instruments for a range of groups: people with disabilities or family members, policymakers, academic experts, or individuals implementing the certification. Each instrument aimed to capture aspects related to the process of implementing the certification, barriers, and facilitators of the certification process. Depending on the type of actor that was interviewed, we emphasised on topics such as the legal and political process of implementing the certification in Colombia (policymakers), the theoretical background of the certification in Colombia (academic experts). In the case of persons with disabilities and individual conducting the certification we focused on the process, barriers, and facilitators. In all the interviews, we aimed to collect information regarding the benefits of obtaining a certification.

The information from each interview was collected before the individual concerned formally approved and consented to the recording of the interview. All interviews were conducted online in 2022 and 2023; the information was recorded and transcribed. All interviews were anonymised, and only members of the research team had access to the audio and transcription. We conducted a thematic content analysis, using a list of defined categories and codes; similarly, the creation of emergent codes was allowed during the coding process. All interviews were conducted in Spanish; thus, once the quotes were identified, the research team translated the quotes, and those were checked by a native speaker to guarantee that the meaning of the quote had not change as a result of the translation.

The research project was submitted, evaluated, and approved by the Ethics Board of the School of Medicine-Universidad de los Andes.

2.3. Thematic Content Analysis

A series of categories and codes were defined to inform the coding of the documents and interviews (Appendix A) [20]. Accordingly, the thematic analysis included the following stages:

• Preliminary reading of documents and interviews: This was performed in order to become familiar with the content and form a general idea of the themes and concepts contained in the collected data.
• Creation of categories and codes: We proceeded with creating categories and codes to organise and classify the information collected, based on the recurring themes and key ideas of the preliminary reading. These categories were the following: social protection, targeting, disability statistics, disability certification, and legislation. Each of these has its respective codes, as evidenced in Appendix A.
• Coding: Data coding was performed; that is, the application of the categories and codes to the pieces of information collected. This phase enabled us to identify patterns and trends in the data and to establish relationships between the concepts.
• Creation of thematic networks: Thematic networks that consisted of grouping the categories and related codes to identify broader themes or concepts were created. This phase made it possible to identify more complex patterns and understand the relationships between the different themes and concepts evidenced in the data.

2.4. Triangulation

The triangulation of information was conducted by reviewing documents and interviews, as well as coding these. In the first place, preliminary readings of the documents related to the Colombian regulatory framework were carried out in order to obtain valuable information that could be used in the thematic analysis. Subsequently, interviews were conducted with key individuals aware of or involved in the disability certification process to supplement the information gathered from the documents and to gain additional perspectives. Once the data were collected, the coding was next: the process whereby labels or codes were assigned to the relevant information units. The creation of categories and codes thus made it possible to identify patterns and trends in the data collected.

3. Results

The social protection system in Colombia is defined as “the set of public policies aimed at reducing vulnerability and improving the quality of life of Colombians, especially the most unprotected. To obtain at least the right to: health, pension, and work” (Congreso de la República de Colombia, 2002, par. 1). For people with disabilities, Act 1145 of 2007 establishes as a requirement the certificate for their identification, characterisation, and location, rooted in information systems. This illustrates that the disability certificate should be a fundamental instrument for people with disabilities to access services and social protection programmes.

In addition, the National Public Policy on Disability does not include a section on certification or assessment of people with disability; therefore, there is no reference to the importance of the disability certificate or how it can be used to ensure access to social programmes or benefits. The Social Protection Act mentions the disability certificate in the case of family allowance and defines disability from a medical perspective, understanding a person with disability as a person who depends on others:

Parents, orphaned siblings and children who are disabled or have reduced physical capacity that prevents them from working will be entitled to a double quota of family allowance, without limitation due to their age. The beneficiary worker must demonstrate that the people are in their charge and live with them.

(Congreso de la República de Colombia, 2002, par. 21)

In this sense, there is evidence of a disconnection between the regulations on social protection and the needs of people with disabilities. Likewise, the operation and development of disability certification in the country create barriers for individuals trying to access the social protection system programmes.

In Colombia, there is a disconnection between disability regulations and the use of the disability certificate. According to Act 361 of 1997, the protection and social integration of people with disabilities in the country must be guaranteed, recognising this group as subjects of rights. Likewise, Act 1752 of 2015 establishes that people with disabilities are a priority population in the context of health care. Despite this, in practice, the use of the disability certificate has become an essential requirement in order to determine access to certain benefits and services, which may limit access to them by people with disabilities.

As evidenced by a certification expert, “the disability certificate is a document designed to identify people with disabilities”, but in Colombia, it is used to determine eligibility for access to programmes and services. In addition, the certification process does not determine the needs of people with disabilities, the reasonable adjustments that are necessary, or the benefits that they can access.

To analyse how the certification of disability is used (or not) in the seven stages of the social protection chain, we analysed (a) the scope of the social protection system and programmes and their outreach to the homes of people with disabilities; (b) the arrival and registration of people with disabilities in social protection programmes; (c) the evaluation of support and conditions required by the person with disabilities in order to access these programmes or benefits of the system; (d) the eligibility of people with disabilities for access to social protection programmes; (e) the determination of the needs of people with disabilities and the care packages that they require; (f) the notification of the decision on access and participation in social protection programmes; and (g) the provision of goods or services provided by the programmes to people with disabilities.

3.1. Access of People with Disabilities to the Social Protection System

In this phase of the social protection chain, we studied the access of people with disabilities to the social protection system using information from the legislation and also what different actors explained. In addition, we analysed the challenges that people with disabilities face when trying to use the system in terms of accessibility and other contextual barriers affecting their access to the relevant procedures.

When studying the process of accessing social protection programmes for the population with disabilities, it is evident that the outreach process of social protection programmes does not contemplate providing reasonable adjustments to make information accessible to persons with disabilities. Indeed, Resolution 1239 of 2022, which modifies and establishes the certification process of persons with disabilities, does not contemplate a communication strategy or approach to the population with disabilities regarding the disability certificate, its benefits, and the requirements that must be met in order to access it; nor is this information provided in accessible formats for different types of disability. Additionally, as mentioned by a policymaker, expert in social protection, social protection programmes are not flexible in their operations for people with disabilities, nor do they consider their needs and requirements in order to ensure their meaningful participation. Therefore, without reasonable accommodation, the programmes cannot include people with disabilities.

“I think the main difficulty, we cannot blame people, we cannot say they lack characterisation. I think it is more of a position, the programmes or processes ’aren’t flexible enough to adapt to’ people’s conditions”.

(Personal communication, policy maker expert in social protection expert 2, 2023)

Thus, it is evident that neither the certificate of disability nor the social protection programmes in Colombia have established a strategy to approach, reach, invite, or register people with disabilities living in different regions of the country or in rural and remote areas. Therefore, the information published by different programmes must be managed directly by people with disabilities. Since most documents are not accessible to individuals with different types of disabilities, access to information is one major barrier to accessing social protection programmes.

3.2. Intake and Registration

The intake and registration stage aims to identify if people with disabilities are able to register to become beneficiaries of social programmes in Colombia. In the case of social assistance, most programmes in Colombia target individuals who are poor or present with high levels of vulnerability to poverty. Programmes targeting older age adults (social pensions) have included people with disabilities as potential beneficiaries. However, disability should be certified.

Given that people with disabilities are not prioritised in most social assistance programmes and that there are no reasonable adjustments that facilitate their process of registration, this group needs to follow the same process as persons without disabilities. None of the documents analysed associated with the structure of social protection presented strategies to prioritise people with disabilities, and experts referred to the difficulties that have been faced in the system to include people with disabilities or to prioritise them.

An expert in social protection mentioned that social protection programmes and, in general, public policies have not been able to establish targeting processes for people with disabilities, due to technical difficulties when obtaining data on this group and, thus, making decisions that respond to their contextual needs. Similarly, the expert affirms that, at the local level, there are still barriers to registering people with disabilities, due to problems with human and technical capacity.

“It is that way for several reasons: first, because blending information systems requires a political command. Blending narratives requires for this command to be written, normative, stamped. To have a territorial training, this political issue is also required. You can achieve this nationally and have a lot of courage in terms of smaller territories… this management in territories is very complicated”.

(Personal communication, policy maker-social protection expert 2, 2023)

3.3. Assessment of Needs, Benefits, and Conditions

The process of assessment of needs is necessary to understand how social protection programmes can provide support to people with disabilities. In the context of Colombia, according to Resolution 1239 of 2022, the disability certificate does not establish the reasonable adjustments required by the person with disabilities, much less the needs of this population. Therefore, the certification of disability does not provide information regarding the specific needs of individuals, and it is not possible to identify if persons with disabilities need particular programmes or how the system can support them to guarantee full participation in society. Therefore, it can be understood that certification in Colombia is an identification process and does not fulfil the role of a needs assessment tool. According to Resolution 1239 of 2022, the certificate of disability is as follows:

Personal and non-transferable document that indicates the personal data of name, surname, type and number of an identity document, place and date of the multidisciplinary clinical assessment, category of disability, level of difficulty in performance, performance profile, professional data of the multidisciplinary team, and QR code

(article 9). (Ministry of Health and Social Protection, 2022, par. 69)

The process of obtaining the certification is the responsibility of the person who wants to be certified. According to Resolution 1239 of 2022, a person needs to request an appointment to be certified by a transdisciplinary group and request a summary of their clinical records, where a medical doctor establishes a diagnosis related to disability. The health insurance will give an appointment to conduct the certification, and after the person has been assessed, he or she will receive a document that establishes whether the person has or does not have a disability. In both cases, the information will be uploaded to the National Register on Disability. The Ministry of Health and Social Protection is the main institution leading this process, and only authorised health providers can conduct a certification process.

Although some of the social assistance programmes in Colombia analyse the needs of individuals and which programmes could respond to those needs, given that there are no specific programmes for persons with disabilities in the country, in most cases, there is no assessment of their needs or an analysis on how social protection programmes can cover those needs. For example, a social protection expert has made the following comments:

“How do our programmes work? When we identify a condition that is not always a need, the possible needs that a family or an individual requires can also be identified; and, during this follow-up, it is possible to know if the needs identified previously are the right ones and if the programmes and benefits provided are the correct ones. However, this does not always happen for persons with disabilities”.

(Personal communication, policy maker-social protection expert 1, 2023)

Considering that the disability certification does not establish the needs or adjustments required by a person when accessing social protection, programmes do not have the relevant information to generate accessible environments and implement the adjustments that people require in order to participate fully. In addition, as a result of the lack of information systems in disability, the country does not have an information source with all the services and programmes, including people with disabilities, or how to adjust those programmes to meet the specific needs of this group. In this context, a social protection expert mentioned:

“We ’don’t have a document that states… or a database that states, ‘this is the national and local offer of the country for persons with disabilities’. That topic ’hasn’t been covered, and that needs to be created, and there is the intention to do it, and that might help to know… what is required for persons with disabilities and how to promote the process…”.

(Personal communication, policy maker-disability expert, 2023)

This disconnection between the certificate of disability, the assessment of needs, and the provision of social protection programmes illustrates some potential barriers faced by people with disabilities in accessing social protection programmes. As indicated by policymakers and social protection experts, programmes including people with disabilities do not adequately respond to the concept of universal design, nor do they involve the results of consultations with people with disabilities or organisations of people with disabilities. Instead, programmes implement adjustments when a person with disabilities has been identified, which makes their participation difficult and imposes an extra effort on the programme to include people with disabilities. For example, an expert in social protection mentioned:

“Another aspect is that, since these programmes are not completely flexible to attend persons with disabilities, sometimes programmes do not contemplate the needs of these groups and forget that they could articulate with other programmes that consider the needs of persons with disabilities and that allow families and individuals to cover their needs associated with disability”.

(Personal communication, policy maker-social protection expert 1, 2023)

In turn, as stated by a person with disabilities, there is no helpful information for people with disabilities living in different socio-economic conditions that enables them to know what programmes and benefits they can access once they have the disability certificate. For this reason, as expressed by a certification expert, it is necessary to create a list of the benefits at the national level, along with a roadmap showing how to access them. This must be shared with people certified with a disability and their families. In addition, there is no information at the local level regarding what reasonable accommodations can be implemented for persons with disabilities. Indeed, according to the information included in the documents, different municipalities can implement concessions or their own programmes for people with disabilities, but there is no data source that includes all the programmes implemented at the local level or how municipalities are committed to guaranteeing the rights of this group.

Finally, as stated by a person with disabilities who has been certified, there is a lack of knowledge on the part of people with disabilities and their families about the uses and benefits of the certificate because it is not explicit regarding the benefits or services that the person can access. In this regard, the following was noted:

“I don’t know about the certificate; it hasn’t been helpful to me. They said it was some kind of help and economic support as a caring mother, in food and support, so as not to be helpless. But they didn’t say when it started or finished. Disabilities are for life, and they should be a priority. But that help hasn’t come, only the one I talked about two months ago, and it was 100,000 Colombian pesos. I don’t really know what it is good for”.

(Personal communication, a person with disability, 2023)

No document was identified that included a list of potential benefits, services, or the provision of social protection programmes for people with disabilities. Given the prevalence of vulnerable individuals with disabilities who live in poverty in Colombia, the certification of disability could facilitate the identification of the needs of people with disabilities as well as facilitate the identification of potential beneficiaries of social protection in the country.

3.4. Eligibility and Enrolment Decisions

The eligibility of people with disabilities for support in social protection programmes does not depend on whether the person has a disability certificate, but on whether the household’s socio-economic conditions are lower than a specific level. Indeed, as stated by a policy maker—expert in social protection, targeting methods in Colombia do not consider disability in their prioritisation criteria: Once the household or the individual has been selected for a specific programme, the condition of disability is requested in some programmes; but in others, this information is not collected. In accordance with this aspect, the expert affirms that:

“In many of our programmes we ask people if they have a disability, and that shows interesting things. It would be ideal to have an information system or a validator to identify if a person does or if a family has a member with some disability; or if these targeting exercises could help to identify, in terms of territories, departments and municipalities, how many deaf individuals or people with motor difficulties live, as well as what their ages are and define the conditions to access the right and timely programmes”.

(Personal communication, policy maker—social protection expert 3, 2023)

The eligibility and targeting processes of social protection programmes, as well as their disconnection with the certificate, have created a situation in which policies, programmes, and projects related to social protection do not adequately respond to the needs of people with disabilities. There are significant difficulties and limitations in merging information systems (e.g., poverty targeting and disability assessment), as explained by an expert in social protection:

“Yes. Additionally, I think we could point out another aspect which is related to information systems, which is a ‘bottleneck’ that exists in the formulation of policies on this topic [social protection for persons with disabilities] … it is the deficit and information asymmetries around programmes and projects of the disability policy”.

(Personal communication, policy maker—social protection expert 1, 2023)

In addition, a social protection expert mentioned that the certification and identification of people with disabilities have not been completely successful in the country because there are still regions where underreporting and incomplete information limit the appropriate design and implementation of policies on disability.

“In both cases, the registry and the certification, there has been a sub-registry, a low coverage in the identification [of persons with disabilities], which limits the implementation of specific policies for persons with disabilities”.

(Personal communication, policy maker-social protection expert 1, 2023)

3.5. Determination of Benefits and Service Package

The disability certificate in Colombia is a tool that identifies people with disabilities. However, the certificate does not determine the needs of the person, the reasonable accommodation required, or the benefits that the person can have access to: “The certification ’doesn’t have any more information. It identifies the type of disability… if it is physical, visual, hearing, intellectual, psychosocial, deaf-blind or multiple” (personal communication, policy maker—social protection expert 1, 2023). Additionally, a certification expert expresses the following:

“Basically, we need to fill out the WHODAS; there is not a section in the document that allows us to include information on needs, the form only includes the domains, the percentages, the codes and the signatures. It does not include anything else”.

(Personal communication, certification expert 1, 2023).

3.6. Notification and Onboarding of the Decision

Regarding how people with disabilities are notified of their formal status, it should be noted that Colombian legislation imposes no requirements beyond the delivery of the certificate: “If it is established that the applicant has a disability, the register of localisation and characterisation of persons with disabilities generates a disability certificate and the multidisciplinary teams should deliver it to the person with disabilities” (Ministerio de Salud y Protección Social de Colombia, 2022, par. 134).

In addition, when a person with disability is selected as a beneficiary of a social protection programme, no specific measure is used to communicate this decision. Indeed, legislation on disability and social protection does not establish any reasonable accommodation to guarantee that the information is provided in accessible formats. Finally, there is no information regarding what types of measures programmes should be implemented to ensure that persons with disabilities can have access to the process of receiving a social protection benefit.

3.7. Provision of Benefits and/or Services

The final stage of the social protection delivery chain includes the provision of benefits and services to people with disabilities. In this stage, the disability certification does not play an important role, and there is no information regarding how people with disabilities who have been selected as beneficiaries have access to services. People with disabilities who were interviewed commented that no reasonable adjustments were made to help them receive the benefit, and that accessibility is not guaranteed.

4. Discussion

Our research aimed to understand how the certification of people with disabilities has been integrated into the social protection system in Colombia. We used the seven stages of implementation of social protection programmes proposed by Lindert et al. [19]. We analysed whether the disability certification was used or provided evidence to implement any of the seven stages of the process. The results revealed that the certification of disability is a process unrelated to the implementation of social protection programmes in the country. Although, in some cases, the certification is used to identify potential beneficiaries, this process is not always clear, and people with disabilities are identified only after the household or individual has been targeted based on their levels of poverty. Therefore, in Colombia, the social protection system does not consider disability certification as an instrument for registration, identification, and/or targeting of people with disabilities.

Given that the certification of disability in Colombia mainly aims to identify individuals living with a disability and does not conduct a needs assessment or collect additional information, it is not possible to use it to assess and design social protection programmes for this group. The mismatch between the objectives is one of the reasons why individuals do not see the added value of having a disability certification, and it is not clear what their benefits are or how it can contribute to the inclusion of people with disabilities in social programmes.

People with disabilities face barriers to their access to social protection programmes, which are related to a failure to implement reasonable adjustments for people with disabilities to guarantee their participation in social protection programmes. One important example is the lack of accessible information on how to obtain the certification and enrol in social protection programmes in the country. The analysis of the seven stages of the social protection chain revealed that no strategies to reach people with disabilities have been implemented in any of the social protection programmes available in the country, also there is not a list of potential benefits that individuals with a certified disability can obtain and targeting process are based on the levels of poverty of individuals and households and not the existence of a disability. These problems in information and use of the information are fundamental barriers to accessing social protection in the country.

The determination of social benefits in the social protection system in Colombia is not aligned with the needs of the population with disabilities. One of the main reasons for this is the lack of information systems providing up-to-date information regarding the needs of people with different functional difficulties. This information could be collected during the process of disability assessment; however, currently, this information is not collected, and according to the interviewees, there are no plans to collect additional information. Therefore, the certificate only identifies persons who are living with disabilities but does not specify what their support requirements are or what services should be implemented to meet those needs.

The certification of disability is not directly related to the determination of potential beneficiaries or benefits: There is a lack of clarity about the uses of the certification for persons with disabilities. Indeed, such individuals allege that there is no clarity on the benefits of obtaining a certification, and they observe that, given the costs associated with the process, there is no incentive for persons with disabilities to apply for certification. Thus, the country needs a clear roadmap that presents the importance of the certification and why any individual who self-identifies as a person with disabilities should be assessed.

According to Cote et al. [11], it is recommended that persons with disabilities be included in mainstream and disability-specific schemes. However, only a few countries around the globe have completed this, and still, social benefits for people with disabilities are limited in most LMICs [15]. Although the recommendation is to use the certification on disability to collect information on the needs of persons with disabilities and to have information to design and implement programmes to guarantee the fulfilment of the rights of this group, to date, no information is available on how needs assessments should be conducted and how they are used in social protection programmes.

In Colombia, to date, there are no specific programmes covering the additional costs of disability, and mainstream programmes only cover a limited number of persons with disabilities, who are not prioritised according to their disability status but mainly on their levels of poverty [18]. According to the results of this study, the information generated by the certification has not been properly used for the identification of beneficiaries in the social protection system, given the low coverage of the certification and the difficulties that people with disabilities report facing when trying to obtain certification [21]. Therefore, this has become the main barrier that explains the lack of visibility that persons with disabilities experience in the social protection system.

Information systems are key to the implementation of social protection programmes [22]. Without them, it is not possible to identify beneficiaries or implement any type of support programme. Colombia does not have a household social register that includes information on disability. The lack of information systems, including information on disability, is a common problem in social protection systems: For example, in India and Malaysia, it was identified that the lack of information systems is a barrier to access to social protection for the population with disabilities [6].

Colombia faces a range of particular challenges in the implementation of social protection systems that include people with disabilities and promote their full participation in society. It is necessary to improve the disability certification process so that a greater number of persons with disabilities can be assessed and certified. In addition, the information that the certification generates should include the assistance needs of people with disabilities, aiming that social protection programmes can be designed to respond to those needs and provide the support that this population group requires in order to guarantee its members’ participation in society on equal terms.

Although the certification of disability can become a tool for the inclusion of people with disabilities in social protection programmes, it should be complemented by a perspective of inclusion in all social and human development areas. In addition, the certification cannot become a barrier to the inclusion of people with disabilities in different services or a source of discrimination against this group. In Colombia, the lack of processes to facilitate access to certification has been identified as a “bottleneck” for access to social protection services [17]. The analysis of how the certification can contribute to the analysis of social protection needs to consider the purpose of the certification, as well as the process of implementing it.

5. Limitations

The results presented in this article provide important information on how the disability assessment is understood and used in the social protection system in Colombia. However, the methodology and results have some limitations. First, although the research team tried to recruit a larger number of participants, it was difficult to find individuals, especially people with disabilities, who would like to participate in the study, which limited the perspectives included in the analysis. Second, we aimed to include the voices of national and local policymakers, but obtaining information from local policymakers was impossible.

6. Conclusions

In Colombia, the disability assessment and certification process is not used as a tool in the social protection system. People with disabilities who have been certified do not have access to additional benefits or programmes. One of the most critical barriers to the use of disability assessment as part of the social protection system is the lack of information systems that include data on disability and poverty. Also, information on disability is used only after households have been identified as beneficiaries of social programmes, and the disability assessment does not include information on the needs of persons with disabilities; therefore, social protection programmes do not respond to their needs.