Pascale Hall,3 Johannes Trimmel,4 Monday Ojonugwa Okwoli5 and Amina Nasiru6
Abstract Health is a development priority across countries and contexts. Yet many health systems are still not accessible for people with disabilities. The Inclusive Family Planning project (IFPLAN), part of the UK aid-funded Disability Inclusive Development Inclusive Futures programme, operates in Northern Nigeria to improve access to sexual and reproductive health for people with disabilities. It partnered with the Lafiya project – a UK aid-funded mainstream health programme – on putting disability inclusion into their practice. In a team consisting of two Inclusive Futures management staff, a disability specialist seconded to the Lafiya project, and a woman with disabilities from the Nigerian National Association of the Deaf, we led the process to identify lessons from this collaboration. In this article, we address the central question, ‘What is needed to support the implementation of inclusive health in mainstream programmes?’ We offer eight practical recommendations to enhance equal access for people with disabilities, adaptable across contexts.
As of 2021, approximately 1.3 billion people – about 16 per cent of the global population – experience disability (WHO 2022). Despite progress, the global health system remains far from achieving equitable health care for people with disabilities, with persistent disparities across disability types and health outcomes highlighting systemic inequities (ibid.). Health systems must evolve to provide accessible, affordable care throughout the life course, from prevention to palliative services. Yet disability-inclusive health initiatives receive minimal attention and funding, with only 0.4 per cent of development health financing allocated to this area (Kuper et al. 2025). These gaps risk widening amid declining global health budgets and reduced focus on equity. In low- and middle-income countries especially, mainstream health programmes often fail to reach marginalised groups, leaving many people with disabilities without the care they need.
Inclusive eye health project, Nigeria, eye test
Photo credit Nelson Owoicho/Sightsavers
In the UN Convention on the Rights of Persons with Disabilities (CRPD), State Parties recognise that people with disabilities have the right to the enjoyment of the highest attainable standard of health without discrimination based on disability. It states that, among other measures, States Parties shall provide persons with disabilities with the same range, quality, and standard of free or affordable health care and programmes as provided to other people, including in sexual and reproductive health and population-based public health programmes (UN 2006).
The Seventy-fourth World Health Assembly reaffirmed the legal obligation to uphold ‘the highest attainable standard of health for persons with disabilities’ (WHO 2021: 5). The resolution urges member states, among others, to:
(WHO 2021)
At the request of the World Health Assembly, the World Health Organization (WHO) published a global report recommending three key implementation principles:
(WHO 2022)
Despite international legal obligations, policy frameworks, and guidance from WHO, people with disabilities continue to face exclusion from health-sector initiatives – an inequity that may contribute to significantly reduced life expectancy. A mixed‑methods study revealed that all-cause mortality among people with disabilities was 2.24 times higher than among those without disabilities (Kuper et al. 2024a). Furthermore, modelling indicated a median life expectancy gap of 13.8 years based on disability status (ibid.).
A review by Kuper et al. (2024b) of disability-inclusive health systems underscores a critical paradox: although people with disabilities tend to use health-care services more frequently than those without disabilities, they experience significantly poorer coverage (ibid.). This includes limited access to general health care, cancer care, maternal care, and other essential services. The review concludes that health systems are consistently failing to accommodate the needs of people with disabilities – despite the existence of effective practices that could address these challenges. Health systems need to adapt to include people with disabilities, so that they can truly achieve health for all (Kuper et al. 2024a).
To address the research question ‘What is needed to support the implementation of inclusive health in mainstream programmes?’, this article looks at the collaboration between two development programmes, the Inclusive Family Planning project (IFPLAN) and the Lafiya project, a mainstream health project in the same region that expanded its original scope to embed disability inclusion in its work. IFPLAN, funded by Inclusive Futures and co-led by Sightsavers and the International Disability Alliance (IDA), operates in Northern Nigeria to enhance access to modern contraceptives for people with disabilities, partnering with BBC Media Action and Organisations of Persons with Disabilities (OPDs). The Lafiya project, also UK aid-funded, focuses on strengthening health systems to reduce maternal and child mortality while integrating disability inclusion across health services. For example, through collaboration with IFPLAN and the Clinton Health Access Initiative, the partnership successfully increased health insurance enrolment for women of reproductive age and children with disabilities, leveraging OPDs to onboard people with disabilities.
Building on the principles already outlined, we explore key lessons learned on integrating inclusive health into mainstream initiatives. This article offers practical recommendations for organisations seeking to advance disability inclusion across various contexts. For those committed to equity and sustainability, ensuring health interventions remove barriers and enable meaningful participation for people with disabilities is essential – whether in a specific environment, community, or project.
The reflections on the learning were done within the frame of the three concepts of (1) Universal Health Coverage, (2) healthsystems building blocks, and (3) meaningful engagement and participation with OPDs.
Universal Health Coverage (UHC), referred to in the World Health Assembly resolution as, ‘The highest attainable standard of health for persons with disabilities’ (WHO 2021: 5), and Sustainable Development Goal 3 (SDG 3), is the key concept to achieve equitable, quality, and affordable access to health care. UHC target 3.8 of the SDGs measures the ability of countries to ensure that everyone receives the health care they need, when and where they need it, without facing financial hardship. As Kuper and Hanefeld (2018) conclude, it will be difficult to achieve UHC without a focus on people with disabilities. Changes made to improve coverage for people with disabilities will likely benefit a wider group, including older persons, ethnic minorities, and people with short-term functional difficulties. Disability-inclusive strategies will therefore improve health-system equity and ensure that we ‘leave no one behind’ – a principle established in the SDG framework – as we move towards UHC (ibid.). UHC is a matter of equity, rights, and justice, and all countries need to urgently reinvigorate progress towards health for all (Cuevas Barron et al. 2023). The development programmes we have captured learning from have been built on the concept of UHC, looking at what services are covered, who is covered, and to which extent.
The six core building blocks for health systems established by the WHO – leadership and governance; service delivery; healthsystem financing; health workforce; medical products, vaccines, and technologies; and health information systems – are all key to address health equity holistically. Equity features prominently in the WHO’s framework for action, ‘Strengthening health systems to improve health outcomes’ (WHO 2007).
Primary health, as articulated in the Alma Ata Declaration of 1978, is at the core of Health Systems and Universal Health Coverage. Its underpinning values – universal access, equity, participation, and intersectoral action – should frame healthcare policies and practice. The findings of a meta-synthesis of qualitative studies from 2000 to 2019, suggest that the choice of people with disabilities to seek health-care services or not, as well as the quality of intervention provided by primary healthcare providers, are influenced by: cultural beliefs or attitudinal barriers, informational barriers, and practical or logistical barriers (Hashemi et al. 2022). Our programmes systematically tackled barriers to health-care access, identifying stigma, discrimination, and negative stereotyping as the most significant obstacles. These attitudinal barriers are particularly pronounced in the area of sexual and reproductive health, which was the focus of our largest inclusive health initiative in Nigeria. Negative attitudes from family members, communities, and health-care providers are among the primary barriers preventing women with disabilities from accessing reproductive health services (Casebolt 2020).
OPDs have significant expertise with regard to convening and influencing, as well as their specialised knowledge regarding disability inclusion: ‘It is essential to leverage this expertise by placing OPDs at the centre of the project cycle. Doing so will enhance outcomes and improve access for persons with disabilities’ (Hall et al. 2025: 107). The pivotal role of OPDs when implementing any health-sector action is highlighted in Health Equity for Persons with Disabilities: Guide for Action (WHO 2024). In compliance with the CRPD and in line with the WHO guidance, meaningful participation and engagement with OPDs has been at the core of the Inclusive Futures programme. Co-governed by IDA – the alliance of eight global and six regional networks representing the estimated 1.3 billion people with disabilities worldwide – we have ensured that in our programmes OPDs were intrinsic partners in decision‑making, design, implementation, service delivery, monitoring, and accountability; in line with the Guide for Organizations of Persons with Disabilities: Driving Health Equity Through Inclusive Health System Strengthening (IDA 2024).
This article draws on practical insights from the IFPLAN and Lafiya projects, a desk review of internal and external documents, and qualitative data from key informant interviews conducted in August 2025 with four Sightsavers and IFPLAN team members involved in project implementation. Ethical approval and informed consent were obtained. The desk review and interviews were guided by questions on mainstreaming strategies, barriers and enablers, key lessons, and alignment with global disability inclusion standards. Sources included internal reports, learning pieces, strategic plans, peer-reviewed articles, global health guidelines, and inclusion frameworks.
Analysis followed a thematic framework approach to identify cross-cutting themes. Findings reflect the relevance of these projects to inclusive health and their potential to inform disability-inclusive practices across diverse contexts.
From 2022 to 2025, the IFPLAN–Lafiya partnership in Kaduna State, Nigeria emerged as a powerful example of how disability inclusion can be embedded into mainstream health programmes. It was guided by the Global Report on Health Equity for Persons with Disabilities (WHO 2022) and spanned multiple pillars of the health system. Some of their successful joint interventions are summarised below (Inclusive Futures 2025).
At the heart of the IFPLAN–Lafiya partnership’s success was the leadership of OPDs, in particular the Joint National Association of Persons with Disabilities (JONAPWD), the Network of Women with Disabilities, and representatives from local groups. They were not only consulted but actively represented on the Kaduna State Primary Health Care Board and other decision-making bodies. Their involvement extended to system audits, interdepartmental coordination, and community outreach, empowering people with disabilities to become champions within their local government areas and influence health governance structures such as Ward Development Committees.
Lois Auta, CEO of the Network of Women with Disabilities, Nigeria, summarises the importance of being represented:
When we talk about equity, we are talking about getting everyone in the room and understanding the diverse needs there are in accessing family planning. We need to sit down together and strategise. We need to ask each other questions about how we can share our experiences and expertise and make sure that everyone has access to the health services they need.
(interview, September 2025)
The project’s intentional strategy to put women with disabilities at the centre has been a key success factor in many ways. They acted as mentors and trainers, sharing knowledge with their peers on access to sexual and reproductive health services. Their active engagement with community health promotion teams ensured that the rights and interests of people with disabilities are effectively represented within their communities. The leading role in advocating for the rights of women and girls with disabilities led to concrete changes in government policies and policy implementation. This included an adaptation of the enrolment tools to the Kaduna State Contributory Health Scheme, to make them more accessible and inclusive to prevent the exclusion of marginalised groups.
The engagement of OPDs with the local government and the respective cooperation mechanisms established will be maintained beyond the lifespan of the IFPLAN project.
The partnership also tackled the issue of inclusive data. Working with the Kaduna State Ministry of Health, the IFPLAN and Lafiya projects promoted the integration of disability data into systems such as the District Health Information System (DHIS) and the Health Management Information System (HMIS).
This step was crucial for evidence-based planning and monitoring. When the collection of disability disaggregated data is taken up systematically in the DHIS and HMIS in the future, it will be possible to measure and analyse the gap of service uptake between people without and people with disabilities.
Inclusive health financing advanced significantly when disability rights were mainstreamed into state planning and budgeting meetings, engaging key stakeholders across government, civil society, and development partners. This led to disability-responsive budgeting and a landmark £15.8m, three-year plan to improve sexual and reproductive health rights for 800,000 women and girls with disabilities – 40 per cent funded by the state and 60 per cent by partners in the health sector. Policy inclusion also progressed, with OPDs validating strategic health documents and co-launching a domesticated disability-inclusive sexual and reproductive health policy, backed by a costed implementation plan approved in June 2025.
There was some unintentional impact due to the partnership, such as the acceptance and sign-in of people with disabilities into national public contributory health insurance schemes to address potential financial hardship in accessing health services. Under this scheme, state employees contribute a portion of their monthly salaries, while the government provides additional funding – hence the name ‘Contributory Health Scheme’.
This success demonstrates the added value of the collaboration established between the two projects. While the IFPLAN project focused on addressing stigma and working directly with the health service providers and in communities, the Lafiya project mainly focused on health systems strengthening rather than direct service provision. When disability inclusion was taken up in Lafiya’s strategy, it was logical to also address it in the work on strengthening health insurance coverage, being an important pillar of health systems.
Also, through collaboration between the IFPLAN project, the Clinton Health Access Initiative, and OPDs, the partnership successfully increased health insurance enrolment for women of reproductive age and children with disabilities, onboarding 56,000 people with disabilities in Kaduna State.
Although there were successful outcomes from the IFPLAN–Lafiya partnership, challenges arose, particularly at its beginning. In this section, we focus on two of those challenges, as they were raised by a majority of the key informants, and we have also experienced them in other project partnerships with disability-focused and mainstream projects within and outside the Inclusive Futures programme.
There were no consultations with people with disabilities, OPDs, or representatives from the disability movement in the design phase of the Lafiya project. As one consequence, there were no dedicated budget allocations to ensure that disability inclusion was integrated into their deliverables. This limitation restricted the Lafiya team’s ability to allocate resources for reasonable accommodations for people with disabilities participating in their project. The lack of a donor requirement for disability inclusion clearly reinforces such an omission, as extra costs for areas not included in the donor business case make a proposal less economically persuasive. If an organisation’s funder is not supportive of disability inclusion, or if the organisation is unaware of the donor’s stance, it can be challenging to set aside a budget for this purpose. Once the Lafiya project team saw that the UK Foreign, Commonwealth & Development Office (FCDO) supported this approach and IFPLAN committed resources, disability inclusion efforts gained momentum.
There were no clearly defined Terms of Reference outlining the roles and responsibilities of each project involved in the collaboration. Consequently, participating in discussions and integrating disability inclusion into Lafiya project activities proved to be a challenging task. Over time, the process of integrating disability inclusion into the Lafiya project became progressively smoother. Regular meetings and the involvement of Lafiya project colleagues in the IFPLAN steering committee kept everyone informed about ongoing developments and solidified the partnership. Furthermore, delivering training and workshops on disability and inclusion for Lafiya project staff and health‑care workers led to a clearer understanding of the importance of inclusion, enhanced the sustainability of these efforts, and improved overall engagement. In an online interview, a key informant working for Sightsavers stated, ‘Collaboratively, stakeholders can work together to determine potential solutions, even if they don’t have all the answers initially’ (September 2025).
Despite facing challenges, these initiatives illustrate how intentional collaboration, advocacy, and resource allocation can transform mainstream health programmes into inclusive systems that uphold the rights and dignity of people with disabilities. The collaboration between IFPLAN and the Lafiya project demonstrates that including people with disabilities in health programmes is a shared responsibility that necessitates structured partnerships and accountability.
In situations where health systems strive to be inclusive of individuals with disabilities but which do not have dedicated partners, the following are eight essential steps to help organisations integrate inclusive health into mainstream programmes across various contexts. They derive from the lessons learned from the IFPLA–Lafiya project partnership and align with UHC and the WHO six core building blocks for health systems (WHO 2007, 2021).
To effectively convey the importance of disability inclusion within health initiatives, it is crucial to highlight the existing gaps and provide solid evidence for why these gaps must be addressed. Utilising data that reflects a lack of disability inclusion can uncover significant disparities within health systems, illustrating the urgent need for change. This information can streamline efforts to incorporate inclusion into mainstream programmes by also addressing the actual needs of people with disabilities. Such an approach can significantly improve decision-making processes within the health sector and beyond. This is a first and crucial step to create an understanding among stakeholders that the responsibility for integrating disability inclusion into mainstream health programmes lies with everyone, and not just with ‘specialists’. Sustained advocacy and iterative approaches to foster inclusion will also be needed. As one key informant who works for Sightsavers said,
Start the conversation… present a solid case for it [integrating disability inclusion]… use evidence to show that there is a gap that needs addressing… [then present] some ways on how to address it… [you may not] know all the answers, but you can figure it out together.
(Online interview, September 2025)
6.2 Co-create with people with disabilities and OPDs, engaging them in all stages of programme design and implementation
Co-create with the relevant stakeholders during the design phase, such as OPDs, representatives of the disability movement, and policymakers. According to the CRPD, persons with disabilities, through their representative organisations, should be closely consulted with and actively involved in decision-making (UN 2006). Their participation is essential from the beginning and throughout all stages of programme implementation, as they understand their unique needs and can articulate key unmet requirements to be integrated into the programme’s design and implementation. IFPLAN’s collaboration with the Lafiya project helped embed disability inclusion in health programmes by securing budget provisions for the participation of people with disabilities and their support staff in policy processes. While not always reflected in work plans, these provisions were prioritised during key activities, setting a precedent for state actors to ensure meaningful representation in policy forums.
Including them will ensure that health programmes meet the diverse needs of people with disabilities. The engagement of OPDs in the IFPLAN–Lafiya collaboration encompassed all facets of the project. They not only focused on advocacy within the health-systems framework but also participated in project leadership and activities such as health-worker training and social behaviour change. These efforts were essential for the success of the collaboration.
In addition, it is crucial to include OPDs and representatives from the disability movement in programme governance bodies, similar to the approach taken by IFPLAN when setting up its steering committee. Such structural involvement fosters mutual understanding of inclusion needs and limitations, and identifies best ways to ensure that disability inclusion is integrated at every stage.
It is important to identify ways to integrate disability inclusion in the programme strategy and all activities, so that the entire programme is inclusive for people with disabilities, rather than setting up a separate standalone pillar. Develop a comprehensive plan to support the empowerment of people with disabilities and OPDs, clearly outlining strategies for their involvement and including a budget for reasonable accommodation. This will give people with disabilities a voice, allowing them to represent their own interests. The project team took a strategic approach to identifying various clusters of people with disabilities and addressing their specific needs to ensure meaningful engagement in all activities. For example, individuals with hearing impairments attended meetings or workshops with two sign language interpreters. Those with physical disabilities were asked to specify their specific support requirements, while individuals with deafblindness were invited to bring tactile interpreters. For residential events, accessible venues were prioritised, and communication materials were tailored to meet diverse needs.
OPDs must be in the driving seat to communicate directly with policymakers and clearly articulate policy asks that reflect their lived experiences. OPDs in the IFPLAN–Lafiya collaboration successfully advocated for their inclusion in the technical working groups of the State Health Ministry, where health policies and strategies are discussed. This was accomplished through the joint efforts of IFPLAN and the Lafiya project. Be aware that it takes time to get all stakeholders on board, so this should be planned for in the design phase.
To successfully engage representatives from the disability movement, it is essential to demonstrate commitment by allocating resources. IFPLAN assigned a disability technical expert to the Lafiya project, which significantly enhanced the integration of disability inclusion within the programme. Allocate a specific budget for disability inclusion in programme activity plans, budgets, and monitoring frameworks to effectively reach people with disabilities. This budget should cover reasonable accommodations that may be necessary for people with disabilities to engage meaningfully. Incorporate these provisions during the design phase. In an online interview, a key informant from Sightsavers noted, ‘Now the process is smoother as they have learned from their experiences and are in a better position to budget effectively for disability inclusion’ (September 2025).
IFPLAN facilitated consultations and training on disability inclusion for a range of stakeholders, such as implementing partners, the Ministry of Health, community members, and health-care workers at the primary and secondary levels. To ensure effective training, it helps if representatives from the disability movement conduct the training. Their lived experiences offer deep insights and invaluable knowledge that can truly enrich the learning process for everyone involved.
Once individuals understand the importance of disability inclusion, they become more open to collaboration and acquire the necessary knowledge and skills to engage effectively in the delivery process. Initially, when IFPLAN began collaborating with the Lafiya project, they lacked a complete understanding of the complexities surrounding the disability movement. However, after participating in disability inclusion training and workshops, the Lafiya project team became enthusiastic about the partnership, making the relationship more straightforward to manage. It is important to be adaptable and to compromise with stakeholders to foster a genuine collaboration.
It is critical to emphasise the importance of inclusive health policies and their effective implementation. Aligning advocacy with donor- and government-aligned frameworks strengthens demand and drives greater accountability. For instance, Universal Health Coverage, being a priority for some governments and donors, cannot be achieved without including people with disabilities. To uphold their right to health, health systems must provide access to quality, affordable care throughout every stage of life. Donors play a significant role in this ongoing effort; they must show their commitment to inclusion and provide rigorous evidence that they are intentionally reaching all target groups.
When designing a programme, it is vital to map out relevant policies, laws, and systems to ensure that nothing is missed. This approach helps identify channels that a programme can use to leverage existing structures and policies for greater effectiveness. By doing so, inclusion can be integrated not only into the specific focus of the programme but also into the broader health systems, policies, and laws. Use this insight to advocate with donors for additional resources in their funding proposals regarding disability inclusion, in alignment with the international commitments and frameworks they have signed.
While many programmes may claim success in meeting targets, especially those focused on disability inclusion, this often occurs superficially – merely to meet numerical goals rather than to create genuine impact. Although there is a growing recognition of the importance of inclusivity in programme design, uncertainty still lingers regarding its effective implementation. As a result, organisations may tend to concentrate on outputs instead of pursuing meaningful engagement. A key informant staff member stated: ‘If organisations do not intentionally engage marginalised communities, especially those affected by stigma, they are unlikely to achieve meaningful results’ (September 2025).
To successfully implement inclusive health in mainstream programmes, it is crucial to include people with disabilities from the outset. Essential lessons learned for embedding disability inclusion into mainstream programmes across diverse contexts include: emphasise the importance of building a strong case using inclusive data; advocate for co‑creation with people with disabilities and their representative organisations throughout all stages of programme design and implementation; engage a twin-track approach, ensuring that disability inclusion is integrated across every aspect of the programme; ensure financial commitment with a dedicated, reasonable accommodation budget line to support inclusion efforts; recognise the value of consultations and training led by disability movement representatives to foster understanding and capacity; and make certain that health-care investments are inclusive of people with disabilities to ensure equitable access and outcomes.
These strategies provide a proven approach for integrating disability inclusion into mainstream health programmes in various settings. Central to this approach is collaboration with OPDs, whose expertise and lived experiences help ensure that programmes genuinely reflect the needs of people with disabilities – ultimately improving health outcomes. To make meaningful progress, it is essential that governments and donors actively support and prioritise inclusion across all health-related initiatives, policies, and legislation. Finally, it is critical for health programmes, donors, and governments dedicated to leaving no one behind to follow these essential lessons learned, to ensure that people with disabilities have equal access to health care.
1 This issue of the IDS Bulletin was supported by UK aid under its flagship Disability Inclusive Development (DID) programme. The DID programme was delivered through two separate programmes. The eight-year consortium intervention, Disability Inclusive Development Inclusive Futures (Inclusive Futures) programme, led by Sightsavers and the International Disability Alliance, ran from August 2018 to March 2026. It has reached more than 19 million people and generated almost 300 learning and evidence resources to inform policy and practice on disability-inclusive development. The evaluation programme, the Programme for Evidence to Inform Disability Action (PENDA), was delivered by the London School of Hygiene & Tropical Medicine. The opinions expressed are the authors’ own and do not reflect the views of the funders.
2 The lead author is Pascale Hall, Senior Learning Advisor – Disability Inclusive Development at Sightsavers, and the article is co-authored by Johannes Trimmel, Programme Director - Disability Inclusive Development at Sightsavers, Monday Ojonugwa Okwoli, Disability Inclusion Advisor at Sightsavers Nigeria, and Amina Nasiru, a member of the National Association of the Deaf in Nigeria and a person with disabilities.
3 Pascale Hall, Senior Learning Advisor, Disability Inclusive Development, Sightsavers, UK.
4 Johannes Trimmel, Programme Director, Disability Inclusive Development, Sightsavers, Austria.
5 Monday Ojonugwa Okwoli, Disability Inclusion Advisor, Sightsavers Nigeria.
6 Amina Nasiru, Women Leader, Advocate for Disability Inclusion, Joint National Association for Persons with Disabilities (JONAPWD), Nigeria.
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© 2026 The Authors. IDS Bulletin © Institute of Development Studies | DOI: 10.19088/1968-2026.161 This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 International licence (CC BY), which permits unrestricted use, distribution, and reproduction in any medium, provided the original authors and source are credited and any modifications or adaptations are indicated.
The IDS Bulletin is published by Institute of Development Studies, Library Road, Brighton, BN1 9RE, UK. This article is part of IDS Bulletin Vol. 57 No. 1 March 2026 ‘Building Disability-Inclusive Futures’; the Introduction is also recommended reading.