All people with disabilities should expect equitable access to services and equal opportunities; the UN Convention on the Rights of Persons with Disabilities explicitly recognises the importance of their full and effective participation and inclusion in society. However, particularly in low-income countries, people with disabilities with high support needs compared to other people with disabilities do not always benefit equally from existing policies, development projects, services, or practices.

This article reflects on learning gathered from across the Disability Inclusive Development programme. It asserts that strengthening inclusion of people with disabilities with high support needs requires not only practical know-how at project level, but also systemic change to funding practices and project design. We identify key areas where collective focus and systemic change would ensure development programmes more commonly include people with disabilities with high support needs, who are often the hardest to reach and the most marginalised and excluded.