Situation analysis of disability and ageing in Myanmar

1. Background

HelpAge International, established in 1983, has supported Myanmar since 2004 and has been an implementing partner of the Livelihoods and Food Security Trust Fund (LIFT) since January 2010. Building on its field experience, HelpAge began a policy oriented project funded by the LIFT donor consortium in 2014, called Strengthening the Ministry of Social Welfare To Fulfil Its Role in Expanding Social Protection. The project addresses gaps in social protection capacity through support to and collaboration with the Ministry of Social Welfare, Relief and Resettlement (MSWRR) which is set to play a central role in the extension of social protection systems. The project will continue until end 2018. The project team is based within the offices of MSWRR’s Department of Social Welfare (DSW) in Nay Pyi Taw, where it provides ongoing advice and services to the department.

 

Disability is a key component of social protection, and an important consideration in ageing. It is estimated that 15% of the population worldwide or some 1 billion individuals live with one or more disabling conditions. An estimated 46 per cent of older persons—those aged 60 years and over—have disabilities and more than 250 million older people experience moderate to severe disability. Looking ahead, the global trends in ageing populations and the higher risk of disability in older people are likely to lead to further increases in the population affected by disability.  An accumulation of health risks across a lifespan of disease, injury, and chronic illness contributes to the higher disability rates among older people. Older persons with disabilities face a number of obstacles including attitudinal, environmental and institutional barriers preventing their full and equal participation in all aspects of life. Promoting and protecting the rights and dignity of older persons and facilitating their full participation in society is an integral part of the pursuit of the 2030 Agenda for Sustainable Development which pledges that no one will be left behind.

 

Myanmar still has very limited government-provided social protection systems, despite approval of a National Social Protection Strategic Plan (NSPSP) in December 2014. As one of its 8 flagship schemes, the NSPSP included an allowance for persons with disabilities (PwD), though it is not yet operational or funded. According to the NSPSP, a disability allowance is to be provided to all certified with disability, after enactment of a disability law. The NSPSP also says that “The programme will be implemented across the entire country, and MSWRR will be the leading agency.” A Law on the Rights of Persons with Disabilities was approved in Myanmar in 2015. Chapter 11 of the law outlines Registration of Persons with Disabilities, including medical certification, though the specific steps and procedures are yet to be detailed. MSWRR is to carry out the registration activities under this law, and social workers from the Regions and States are to be assigned as registration officers. The Law states that “internationally accepted norms and practices are to be followed.”

 

2. Purpose

The purpose of this assignment is to conduct a situation analysis of disability and ageing in Myanmar, set within an understanding of international trends and literature. The report will also include analysis and recommendations to inform HelpAge’s programming. 

 

3. Specific Tasks for Consultant

The study includes key informant interviews of selected actors in Yangon and Nay Pyi Taw and no community field work and is therefore otherwise largely desk based.  Specifically the tasks include:

 

  • Hold discussions with HelpAge to clarify the outline and scope of the task. Agree a workplan, research plan and revisions to Output 3 outline.
  • Summarise a review of international literature on broad trends in understanding and responding to disability, including debate on the balance between medical considerations of impairment and social/environmental barriers and facilitation to expand functional ability. In broad terms, summarise the literature – and literature gaps – in relation to disability and ageing. From a global perspective, discuss how actors working on issues of disability frame the relationship between old age and disability. Produce Output 1 for comment.
  • Conduct a national literature review on disability in Myanmar and begin drafting Output 2. This is a desk review of key documents related to disability in Myanmar, including studies and surveys, as well as relevant Government documents. Identify data sources for the study.
  • Produce a list of key contacts for key informant interviews (KIIs) or for investigation by email for approval by HelpAge. Conduct KIIs in person in Yangon and Nay Pyi Taw.
  • Based on information obtained during KIIs, complete Output 2 for comment.
  • Conduct data analysis.
  • Assess and synthesize the results and produce Output 3, the report, seeking clarifications from HelpAge as needed.
  • Prepare the Output 3 attachment: Specific advocacy and programming recommendations for HelpAge International
  • Incorporate comments/feedback and revise Output 3.

 

4. Methodology

The study requires no community field work or primary data collection. The methodology comprises the following. (1) A broad summary of international literature on disability, and ageing and disability, and the key points of debate and general agreement, to set the context for the Myanmar discussion. This includes an overview discussion of the broad trends in responding to disability. The consultant team is expected to be familiar with international literature on disability already and the role of the Convention on the Rights of Persons with Disabilities (CRPD), and no extensive new literature review is anticipated.  See indicative outline of Output 3, below. (2) A Myanmar literature and document review on disability, resulting in an annotated bibliography including least 15 of the most significant works found relevant to a disability situation analysis for Myanmar. For example, this may include surveys, academic studies, position papers, CSO reports and government policy documents, published and unpublished. It should exclude clinical and medical research and small-scale local interventions, while instead focusing on disability prevalence, analysis of environmental barriers and national responses (policy, programmes, services). HelpAge anticipates relatively little specific Myanmar literature on ageing and disability. (3) Data analysis, especially further age disaggregation of existing data. At a minimum this will include additional analysis of published data in table form, but ideally include disaggregation analysis of existing datasets, implying access to raw data. Potential sources of data may include the 2014 Census, the 2010 Myanmar National Disability Survey and data from the Situation of Older Persons in Myanmar. Particularly where there are data gaps, Myanmar data should be considered within the light of international data on disability. Consultants are encouraged to mention any relevant datasets they have access to and propose to analyse.  (4) Key informant interviews in person in Yangon and Nay Pyi Taw.  The consultant should conduct KIIs with at least 15 key stakeholders based on discussion with HelpAge. Indicatively these include interviews with at least 5 key government staff (including staff from the Ministry of Social Welfare, Relief and Resettlement and Ministry of Health and Sports) and interviews with 10 civil society institutions (including international and national NGOs and academic bodies) in addition to HelpAge. The targets may include some public or private service providers, although it is an assumption that service provision outside of hospitals and NGO services is currently relatively limited for PwD in Myanmar. In addition to KIIs, the Consultants may wish to contact other parties electronically. 

 

5. Outputs

The Consultant is responsible for producing the following three Outputs in English:

 

  • Output 1: Overview of international literature and debates on disability, and specifically disability and ageing (about 10 pages). No annotated bibliography is required, but key sources should be referenced in the discussion. To be incorporated later in the final report (see chapters 2 and 3 of Output 3).
  • Output 2: Annotated bibliography based on a Myanmar national literature review (to be annexed later to Output 3). This should briefly summarise (1-2 paras each) the scope/purpose and key findings at least 15 of the most significant works relevant to a disability situation analysis for Myanmar. Highlight any national literature/discussion on disability and ageing.
  • Output 3: Situation analysis report. The report of about 30-40 pages plus annexes (including Output 2) will synthesize the findings from all components of the study (see Methodology above) and Outputs 1 and 2. This includes specific advocacy and programming recommendations for HelpAge International (annex of about 5 pages).

 

The structure of the report (Output 3) should be discussed with HelpAge in advance but an indicative outline is attached to this TOR. This outline may be revised in discussion with the Consultant. Given the broad scope of the study (see attachment), it is expected to provide a well-referenced analytical overview, based on the consultants’ expertise and documented evidence, not an in-depth discussion of each topic. The consultant should write the Outputs in clear English so that they can be easily understood and translated, avoiding complex sentences, jargon, and abbreviations as much as possible.  Technical terms should also be clearly explained or else avoided when possible. The study may also contain numbered/bullet points, diagrams, or other visual materials to illustrate material and guide the reader.  Detailed textual material or forms could be annexed.

 

6. Time requirements and duration

Late November 2017 – Consultant appointed

December – Desk-based research and preparation for visit

December-January – Drafting of Outputs 1 and 2

January – Initial discussions in Myanmar

Late January – Preliminary observations in writing for government planning purposes

January-February – Data analysis

February – Follow-up discussions and interviews in Myanmar

February-March – Report writing

Mid-March – First draft of Output 3

End March 2018 – Assignment including reporting finished

 

7. Qualifications of consultant

HelpAge anticipates hiring a team combining (a) familiarity with international experience and literature as well as (b) Myanmar expertise and contacts. Both aspects are essential, as are skills related to the Methodology in section 4 above. However, experts in one aspect of the study who are not members of a team may apply alone and later be paired with one or more other experts upon mutual agreement. The members of the team, between them, should have the following qualifications:

 

Essential

  • Advanced degree(s) in a field relevant to the nature of the study
  • In-depth familiarity with international literature and debates on disability
  • Demonstrable expertise in disability assessment and response in low income contexts
  • Familiarity with Myanmar context, actors, data sources and evidence
  • Demonstrable experience related to social services in Myanmar
  • Data analysis and related software skills
  • Demonstrable experience producing similar documents
  • Understanding of social protection
  • Strong research and interviewing skills
  • Strong writing skills in English with a clear, simple writing style
  • English and Myanmar language fluency within the team
  • Exceptional analytical and summarising skills
  • Diplomacy, tact and cultural awareness
  • Appropriate IT/computer skills

 

Desirable

  • Experience advising Myanmar or other governments on disability or social protection
  • Strong understanding of social protection and cash transfer schemes
  • Deep understanding of ageing and the needs of older people
  • In-depth familiarity with international literature on ageing and disability
  • Experience working with the Government on social issues
  • Familiarity with Myanmar government policy and programmes on disability
  • Familiarity with key CSO actors on disability in Myanmar

 

8. How to apply

Interested consultants are invited to submit an expression of interest for carrying out this documentation by 21 November 2017 by email to Ms Chitlekar Parintarakul at fon@helpageasia.org. The short Expression of Interest (about 4 pages) should include:

 

  1. Proposed methodology and any comments on this TOR
  2. Clear work plan including output/deliverable and time frame for each stage
  3. Proposed budget (see below)
  4. Appendixes (not included in 4 pages)
  1. CV of the consultants
  2. Contact information for 2 professional references
  3. Relevant studies previously produced (1-2)

 

As mentioned above, although EOIs from full teams are preferred, experts in one aspect of the study (e.g. international literature) who are not members of a team may apply alone and later be paired with one or more other experts upon mutual agreement. Consultants are encouraged to mention any relevant datasets they have access to and propose to analyse (see part 3 under Methodology above). The costing/budget for the EOI should include professional fees including daily rates x no. of days per component, and any other costs to carry out the full study. Expected travel should be described, including number of travel days by location (travel currently expected to include Yangon and Nay Pyi Taw). Travel costs may be included in the consultant’s EOI budget or excluded and discussed separately with HelpAge later, and based on HelpAge practice and rates. No more than one international trip to Myanmar is anticipated, for team member based outside the country. Selection of the consultant will be by a panel and based on the experience of the consultant team, the quality and relevance of the EOI, and the proposed budget (i.e. value for money, within resources available). Final negotiated fees will be specified in the consultancy contract.


 

Attachment: Indicative outline of situation analysis report (Output 3)

 

  1. Background, definitions and scope

International context (one-third or less of the report)

  1. International context
  • Scope and distribution (including gender) of PwD population and classifications of disability
  • Evolving global understanding of disability, including impairment and environment
  • Role of key global instruments and agreements, including the CRPD and SDGs
  • Association between poverty and disability, including poverty implications of caregiving
  • Ageing and disability: Key considerations
  1. International response
  • Interactions between health care, NCDs, long term care, social protection and disability
  • Interactions between ageing and disability in national responses, incorporating gender
  • General trends in assessing disability
  • General trends in responding to disability and lessons from experience
    • Services
    • Disability allowances and cash grants
    • Environment and barriers
  • Trends and debates in policy development and advocacy including role of CRPD

Myanmar situation (about two-thirds of report)

  1. Perceptions of disability in Myanmar
  • Culture/society, disability, gender and ageing in Myanmar
  • Evidence of current or changing perceptions to disability including disability in old age
  • Factors affecting perceptions: Individual, family, community, society, government
  1. People with disabilities in Myanmar (general population and older people)
  • Extent and limitations of evidence
  • Estimates of population size and distribution, including geographic, age and gender considerations
  • Evidence about the forms of disability, including impairment and environmental considerations
  • Evidence of association between poverty and disability
  • Demographic trends (especially population ageing and migration) and their implications
  1. Institutional and policy context in Myanmar
  • Evidence of informal response of Myanmar society to disability
  • Policy, legal and rights context including Myanmar’s status in relation to CRPD
  • Institutional responsibilities regarding disability, including government institutions
  • Current and evolving priorities of the government
  • Types of public and private services and providers related to disability, and reach
  • Interactions between health care, NCDs, long term care, social protection and disability
  • Priorities and activities of national civil society actors
  • Priorities and activities of international actors and donors in Myanmar
  • Critical challenges in institutional and policy response
  1. Recommendations: ageing and disability in Myanmar
  • Policy gaps and recommendations
  • Service provision gaps and recommendations
  • Awareness/perceptions gaps and recommendations
  • Evidence gaps and recommendations

Attachments:

  • References cited
  • Myanmar annotated bibliography (Output 2)
  • Specific advocacy and programming recommendations for HelpAge International

 

Download TOR - Situation analysis of disability and ageing in Myanmar

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