We adopted a retrospective analytical review methodology to review the Malawi National Disability Mainstreaming Strategy and Implementation Plan [8] using the EquIPP (Equity and Inclusion in Policy Processes) tool [2]. The EquiPP tool measures the extent to which equity and inclusion were adopted in the process of policy development, implementation and evaluation [2]. This tool has been previously used in the review of Malawi’s National HIV and AIDS Policy [13].
The Malawi National Disability Mainstreaming Strategy and Implementation Plan (NDMS&IP)
Although Malawi has a National Policy on Equalisation of Opportunities for Persons with Disabilities (NPEOPWD) developed in 2006 [14], the NDMS&IP was developed to bridge the gaps between policy and practice in disability. Hence, the NDMS&IP was an attempt by the government to develop a strategy for promoting inclusion of disability issues in sectoral policies and strategies.
The NDMS&IP was a product of the joint effort of various stakeholders including the Department of Disability and Elderly Affairs (DDEA) in the Ministry of Gender, Children, Disability and Social Welfare (MGCDSW). In addition, there were stakeholders and technical experts from government ministries (Health, Education, Science and Technology, Labour and Manpower Development), local and international NGOs and persons with disabilities drawn from the Federation of Disability Organisations in Malawi (FEDOMA). The process was consultative and included a stakeholder consultation workshop.
The Equip Framework
The EquiPP framework was developed to support Equity & Inclusion equity and inclusion in the processes of policy development, implementation and evaluation in diverse policy contexts including low, middle- and high-income settings. It was developed between November 2014 – February 2016 through a literature review of stakeholder methodologies to equity and social inclusion. The process was iterative and involved multiple rounds of stakeholder consultations and revisions using feedback from both high- and low-income settings.
It consists of 17 Key Actions expected to guide and ensure equitable and inclusive policy processes. The 17 Key Actions are sub-divided into nine themes: inclusive and participatory policy procedure; cross-sectoral and intergovernmental cooperation and coordination; matching social need and provision; social budgeting, inclusive and responsive implementation; implementation partnerships and cooperation; multi-dimensional and context driven data collection; data-fit-for-purpose and comprehensive and inclusive dissemination system [2]. The tool was developed in collaboration with the UNESCO Management of Social Transformation (MOST) (Management of Social Transformation) programme and the United Nations Partnership for the Rights of Persons with Disabilities (UNPRPD) programme. The process entailed extensive literature review, review of other instruments and expert opinion from across UN agencies and civil society [2]. The tool uses an assessment matrix (checklist) to assess the extent to which policy processes qualify as equitable and inclusive. It applies the Policy Engagement Key Action Scale (PEKAS)[2] which is a 7-point scale (0-7) (Table 1) to assess the 17 Key Actions. The assessment can be done in real time or retrospectively.
Analysis
We conducted the analytical review process in three stages. In the first stage, two independent researchers (IDE and EMS) reviewed the NDMS&IP using the EquIPP tool across the 17 Key Actions. Thereafter, the raters met to discuss and resolve the differences in rating.
In the second stage, the results of the review and rating were shared with two of the co-authors (A M and SWM) who are experts in disability research and policy in Malawi and had first-hand knowledge of the development and implementation of the NDMS&IP. We drew on their knowledge for the analysis, particularly where there were questions which could not be resolved through evaluation by the independent reviewers.
In the third stage, the results of the analysis from the researchers were presented to the Action Research Group (ARG) the APPLICABLE project [12]. The ARG consist of 15 stakeholders purposively selected from users and providers of AT and experts on disability in Malawi. The ARG are leading on the process of the policy development in collaboration with the research team [12]. The feedback and recommendations from the ARG were incorporated into the results presented herein.
Table 1: Policy Engagement Key Action Scale (PEKAS) assessing the extent to which engagement with stakeholders has been a central element of the policy development and/or implementation process.
Pol Policy Engagement Key Action Scale (PEKAS)
|
Rating
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Absent – no evidence it has been considered
|
0
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Recognition – evidence of awareness but no associated action
|
1
|
Minor action – evidence of token or minimal efforts to engage
|
2
|
Moderate action – evidence of clear but incomplete or partial engagement
|
3
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Comprehensive action – evidence that all reasonable steps to engage have been taken
|
4
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Policy evaluation– reference to Key Action in core document(s)
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5
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Process Evaluation – evidence gathered from diverse stakeholders of satisfaction with the process of engagement
|
6
|
Outcome Evaluation - evidence gathered from diverse stakeholders of satisfaction with the outcomes of engagement
|
7
|