1. Introduction
Despite the significant improvement in access to schooling worldwide due to countries’ collective efforts, children with disabilities still face challenges in access to schooling and academic achievement. Out of a total estimated 122 million primary school-age children worldwide being out of school in 2011 [
1], almost 50% of persons with disabilities (PwDs) are out of school, and among them, 85% never enroll in schools [
2], which is evidence of how big the educational attainment gap between children with and without disabilities is.
The MDG framework completely overlooks disability issues in its goals, targets, and indicators. This lack of attention to disability has posed difficulties in making efforts toward meeting MDG and Education For All goals [
2]. By learning the lesson from MDGs, organizations of PwDs and people in academia strongly advocated their governments, and, therefore, the Sustainable Development Goals (SDG) adopted in September 2015 recognized disability as one of the factors that influence equity and inclusive development. Goal 4, in general, and Goal 4.5, in particular, of the SDGs have clearly incorporated the education of vulnerable children, including those with disabilities [
3].
While 2015 marked the end of both the MDGs and Education for All (EFA), the EFA Global Monitoring Report 2013–2014 indicated which countries were expected to achieve each goal and which were not [
4]. While the majority of countries were assessed as having reached or being close to the goals, access to quality education for PwDs is yet to be achieved, particularly in low- and middle-income countries. While access to school for children with disabilities is an important component of inclusive development, their lower access to, and achievements in, education, particularly in the developing world, indicates the likelihood of less emphasis being placed on increasing access, which, consequently, provides lower quality education [
2,
5,
6,
7]. Despite initiatives such as the Universal Primary Education (UPE) policy, the education of children with disabilities may be compromised, particularly with respect to households in poverty.
Reliable information on the number and educational status of children with disabilities is scarce due to a lack of standardized and detailed questions on disability in household surveys [
8]. In the absence of internationally comparable data, efforts to evaluate the impact of disability on key educational parameters such as attendance are disrupted, and governments rarely possess the necessary evidence required to design appropriate policy adaptations and enhancements to improve the situation of children with disabilities [
9].
Therefore, in this paper, using an internationally tested and comparable measure of disability, we examined and compared the effect of the UPE policy on educational attainment between PwDs and people without disabilities (non-PwDs) in a developing country, namely, Uganda. We use a nationally representative large Demographic and Health Survey [
10] dataset of 2016, from Uganda, which collected information on educational status and administered the Washington Group Short Set (WGSS) of disability screening questions introduced by the Washington City Group on Disability Statistics (WG) [
11].
In this study, we look into two key issues. First, we assess if there are consistent improvements in school attendance based on UPE for children with disabilities. Second, because education is an important determinant of future income and more broadly well-being for individuals, this study also tries to understand why there are educational disparities between children with and without disabilities despite the implementation of UPE. Our reason for focusing on Uganda is that it was one of the first sub-Saharan African (SSA) countries to adopt the UPE policy, which occurred in 1997, and it is considered to be strongly progressing toward achieving the EFA goals but far from achieving UPE and disability parity in primary education. By this study, we aim to partially fill the existing lacuna by comparing the effect of UPE on PwDs and non-PwDs. We evaluate the effect of UPE on these groups by comparing the pre- and post-UPE cohorts. By doing so, we are able to observe which groups are more vulnerable in education and which groups require more targeted strategies to improve their educational attainment. We focus our discussion particularly on the following research questions: What is the difference in educational attainment between male and female PwDs and non-PwDs? What factors are associated with the educational attainment of PwDs? Is there any gap within the group of disabilities (e.g., any gender gaps) within PwDs?
This study is a preliminary attempt, given the situation that, to date, to the best of our knowledge, no research has been undertaken to compare the overall impact of UPE on the educational access and achievements of PwDs in Uganda. By this study, we intend to help the government of Uganda as well as bilateral and multilateral agencies design policies that mitigate the educational gap between PwDs and non-PwDs. The originality of this research lies in the nationally representative DHS dataset that includes a short set of questions on disability recommended by the WG. Collated data were analyzed using quantitative techniques such as the difference-in-differences (DID) model. These techniques help identify the effect of UPE, focusing more on gender and severity of disability. The structure of this paper is as follows:
Section 2 discusses the related literature and Uganda;
Section 3 discusses the study context and conceptual framework; in
Section 4, the dataset is described;
Section 5 presents the empirical strategy;
Section 6 presents the results and discussion; and
Section 7 presents concluding remarks.
2. Related Literature
Educational attainment in SSA countries has been stagnant for a long period of time. The gross enrollment ratio (GER) in primary education was 76.1% in 1985 and, surprisingly, fell back for a decade, dropping to 73.9% in 1995 [
12]. Since around 2000, there has been significant progress because of the introduction of the UPE policy in some SSA countries [
13,
14]. This policy abolished school fees for public primary education. Avenstrup et al. (2004) reported that enrollment increased 68 percent in Uganda, rising from 3.4 to 5.7 million in one year, bringing the gross enrollment rate to 123 percent [
15]. Enrollment rose 240 percent over six years in Uganda, with free primary education having a positive effect on the poor. However, despite Uganda adopting the UPE policy in 1997, early among SSA countries, Ref. [
4] shows that the Ugandan GER diminished by 18 percentage points between 1999 and 2012.
Although ample literature has examined the cost of education for both developed and developing countries, studies focusing on the impact of UPE are rare in developing countries. We found two recent and important review articles on UPE in SSA countries, which explored how key aspects of the dominant political economy influence the implementation of UPE policy [
13,
14]. These studies argued that the lack of progress to date in attaining UPE in SSA can only be properly understood by focusing on the wider impact on primary education attainment levels of the combined social, political, and economic forces and processes that characterize a new political economy in the majority of SSA countries. Similarly, in a review of the literature on disability, Ref. [
16] determined the legacy of inequality generated by colonialism and sustained through unequal global progress as the cause of why the majority of children and youth with disabilities and their families in the Global South exist in severe conditions of inequity in education and healthcare.
Likewise, for Uganda, we found numerous important studies examining the impact of UPE on school attendance and educational attainment [
17,
18,
19,
20,
21,
22,
23]. Refs. [
17,
19] found a clear association between UPE and a dramatic increase in primary school attendance and claimed a reduction in gender, income, and regional inequalities in attendance. However, Ref. [
17] also found decreased school fees paid by parents at the primary level but not necessarily at the secondary level. Additionally, by using the data of 940 rural households, Ref. [
18] estimated the effect of the UPE policy in Uganda on primary education attainment and found its impact on decreasing delayed enrollment and increasing grade completion rates up to the fifth grade. The same study also found a strong association between UPE and girls’ enrollment, particularly in the case of poor households. Additionally, using census data and applying the logit model, Ref. [
23] examined predictors of access to secondary education for children in Uganda. The paper found that only 22% of children aged 13–18 were enrolled in secondary school and that demand- and supply-related predictors are moderated by the socio-economic status of households to influence schooling outcomes. Utilizing a predictive model, although they have shown lower educational attainment for PwDs, their framework differed from statistical causal inference for the effects of the education policy; therefore, they did not examine the exact effect of UPE on the educational attainment of out-of-school children.
While these studies indicate the effectiveness of the UPE policy in improving access to primary education for children of poor families by removing tuition for public primary education, none of them examined whether any gaps exist between those with UPE experience and those who were enrolled before the UPE policy, particularly for poor and non-poor households. Likewise, despite the growing realization of the barriers faced by PwDs to complete primary school with better learning outcomes, it remains unclear whether the UPE policy is equally effective in improving access to quality education for children with disabilities in Uganda who may suffer from financial constraints and attitudinal as well as environmental barriers.
In addition, except for that by Ref. [
23], another plausible limitation of these studies is that they did not capture the educational attainments of PwDs; they also did not examine school progression beyond primary schooling. This limitation prevents us from observing the clear effect of UPE on educational attainment. Importantly, as stated earlier, we are not aware of any empirical studies that explicitly compare the effect of UPE on school attendance and educational attainment between PwDs and non-PwDs.
3. Conceptual Framework and Study Context
Decisions of parents to send their children to school can be analyzed through a standard human capital investment framework with supply and demand factors [
24]. Ref. [
2] states that both the quantity of schools (e.g., distance to the nearest school) and the quality of schools (e.g., teacher’s attendance and training, adequate school supplies/facilities) can be considered from the perspective of the supply side, whereas on the demand side, the parents’ decision to send their children to school is affected by the intrinsic value of schooling to them, the direct cost of schooling (e.g., tuition, transportation), the opportunity cost of schooling (e.g., foregone earnings from child labor), their time discount factor, and the expected return from schooling [
2]. As for disability and education, they also state that some schooling environments may reduce learning for children with disabilities due to factors such as inaccessible educational materials and teachers not being trained to teach students depending on the type of disability. Consequently, despite the clearly measurable multifaceted benefits of education, and the impactful yet unmeasurable positive effects, which are known as “other externalities”, PwDs are deprived of access to education itself and, more clearly, to receiving quality education due to several interconnected yet poorly understood factors.
Since the decision to enroll in school and to continue education is primarily made by parents, understanding how parents make investment decisions in the education of children with and without disabilities is critical to identifying where the problems are located in relation to school participation of those with disabilities [
25]. Similar to Ref. [
25], referring to the case of Mexico, Ref. [
26] argued that gaps in schooling for PwDs can be partially explained by parental responses to children’s disabilities. Ref. [
26] further states that parents might invest differently in the education of children with and without disabilities depending on whether parental behavior is driven by efficiency or equality concerns. If parental decision making is driven by efficiency concerns, then parents will allocate resources in order to maximize the total expected earnings of their children [
27]. In this case, parents may provide more resources to children with higher expected returns from education, and therefore they may invest less in those with disabilities than those without disabilities, believing that investment in the education of PwDs gives no or fewer benefits [
25]. However, Ref. [
26] argues that if parental decisions are driven by equality concerns, then parents will allocate resources in order to reduce differences in endowments between their children. Contrarily, he further predicts that if the cost of parental inputs is higher for PwDs than for those without disabilities, even inequality-averse parents might provide more resources to non-PwDs than to those with disabilities.
Given the circumstances above, for an investment in an educational context, disability may influence the parents’ schooling decision in different ways. For instance, Ref. [
25] states that household financial constraints, combined with discriminatory attitudes on the part of parents, may negatively affect their decision to invest in the education of PwDs, in part, resulting from the predicted lower returns from the education of those with disabilities due to mistaken beliefs about their capabilities, or actual lower returns due to barriers in the labor market.
This scenario is likely in the context of UPE policy in Uganda. This is because, although amended later in 2003 to cover all children, in 1997, the government pledged to meet the costs of schooling for only four children per family, and this initial legal provision might have encouraged families to place less priority on their children with disabilities if they had more than four children. Although Ref. [
15] claimed that in Uganda, the government first agreed to provide free primary education for up to four children per family in the form of a capitation grant to the school. In families that included both boys and girls, at least two of the four children had to be girls, and children with special educational needs were given priority over other children. Even if that had been the case, children with disabilities could still be deprived in the households that have four girl children. This could particularly be the case for households living in poverty. Because the UPE policy requires parents to cover the costs of school uniforms, meals, and exercise books [
28,
29], parents with financial constraints who cannot meet these obligations may not be able to send their children to school. This likelihood for parents of children with disabilities is higher in low- and middle-income countries where PwDs and their families often live under both income poverty and multidimensional poverty [
30,
31,
32,
33,
34,
35,
36,
37,
38,
39] and do not place faith in the benefit of education for their children with disabilities [
5]. Furthermore, other than uniforms, textbooks, and assistive devices, inaccessible roads to school or school buildings may require additional transportation costs on the part of parents to send their children with disabilities to school [
2]. As the UPE policy normally subsidizes only tuition fees, leaving other direct and indirect costs to be borne by parents and families, it is likely that PwDs are left behind for the very reason of disparity in household investment strategies. Therefore, equality and equity in education remain a concern under the UPE policy [
18]. In contrast, education of PwDs has been shown to have far-reaching benefits. Considering a Nepal case, Ref. [
39] found the returns on investment in education for PwDs to be 19.2–25.6%, which is two or three times higher than non-PwDs, as reported by Ref. [
40].
While looking at the disability prevalence rate in Uganda, the statistics are somewhat consistent with the global estimate of 15 percent of the population having some form of disability [
41]. According to the 2002 Population and Housing Census in Uganda, almost 16% of the total population has some form of disability. This rate is consistent with the 2011 DHS, which indicates an almost 20% prevalence. The National Population Census, 2015, stated that 15 percent of women and 10 percent of men were disabled in Uganda. In this regard, of the total population of 47,249,585 [
42], approximately 7 million people live with some form of disability. In Uganda, we find some laws and policies pertaining to PwDs’ rights, such as Article 21 of the Constitution 1995, which prohibits discrimination against PwDs. Additionally, the PwDs Act of 2006 has created provisions for equal opportunities by eliminating all forms of discrimination against them together with the Business, Technical, Vocational Education, and Training Act, No. 12, 2008, promoting equal access to education and training for all disadvantaged groups, including PwDs. Moreover, Uganda ratified the United Nations Convention on the Rights of Persons with Disabilities (UNCRPD) and its optional protocol in September 2008. Article 24 of the UNCRPD guarantees equal rights to education for children with disabilities.
4. Dataset
The datasets used in this study were adopted from the nationally representative Ugandan Demographic and Health Survey (UDHS) collected in 2016 [
10]. The UDHS comprises information on women aged 15–49 years and men aged 15–54 years. The survey included questions on individual- and household-level characteristics, such as education, employment, household socioeconomic characteristics, and health.
Importantly, the survey included questions identifying people’s disability status based on a short set of questions recommended by the WG [
11]. These questions categorize disabilities into six types: seeing, hearing, walking, remembering, self-care, and communicating. The definition and measure of disability recommended by the WG has been one of the widely accepted and internationally tested tools. The WGSS2 uses a four-level scale (no, some, or a lot of difficulty; cannot do entirely) to capture individuals’ degrees of functional ability in the aforementioned six basic physical and mental domains. The possible response options are as follows: 1 = “no difficulty”, 2 = “yes, some difficulty”, 3 = “yes, a lot of difficulty”, and 4 = “cannot do at all”. The questionnaire is provided in
Appendix A. Detailed information on the survey design, data collection procedures, validity of the data obtained, and sampling methods can be found in Ref. [
10].
Hence, the questions on disability not only determine whether a person has a disability or not but also indicate its severity. In this study, participants with some or a lot of difficulty are classified as having moderate disability, while those reporting not being able to do much at all are classified as having severe disability. Participants reporting no difficulty are categorized as non-disabled. In this study, we are particularly interested in exploring potential disparities in the impact of UPE based on the severity of disability. Therefore, in addition to comparing the effects of UPE on male and female populations and those with and without disabilities, the analysis also focuses on the disability samples. A key variable, “Severe Disability” is constructed to identify respondents with severe disabilities. We have assigned a value of one if the participant has a severe disability and zero otherwise. The analysis estimates the effect of UPE on people with severe disabilities using only respondents with disabilities, as discussed in detail in
Section 6.2.
Although DHS captures information on respondents’ disability status, there are still some limitations. One of these limitations is the lack of information at the onset of the disability, which could pose a challenge for studies like ours. For example, there may be an assumption that any disability found in individuals at the age at which they are responding is the same disability they faced during primary school. Consider a person born in the 1956 cohort who would have been 60 years old in 2016 while responding to the Washington group. If this person were to answer positively to the question: Do you suffer from remembering? This indicates that they currently suffer from remembering. However, the assumption could be that they were not having difficulty in remembering while in school. This issue could be easily addressed if DHS captured the onset of the disability of the participant. Although we cannot resolve this issue completely without having the information at the onset of disability, earlier studies on the existence of disability have given some ideas on this issue. Studies have found that children and people in low- and middle-income countries experience disability at an early age, and it is possible that due to poverty, they may find it difficult to receive a diagnosis and therefore remain disabled. According to the Uganda National Population and Housing Census conducted in 2014, disabilities can develop during childhood due to various factors, including malnutrition, disease, and injury. The same Population and Housing Census states that there were over 1.6 million people living with disabilities in the country, with approximately 2% of the population aged 0–14 years having a disability [
42]. Numerous studies have shown that disabilities can develop during childhood. According to research conducted by the Centers for Disease Control and Prevention (CDC), approximately one in four children in the United States has a disability [
43]. Other studies by organizations such as the National Institute of Child Health and Human Development (NICHD) and the American Academy of Pediatrics (AAP) have also reported high rates of disabilities among children [
44,
45]. Similarly, Child Trends, a research organization focused on improving outcomes for children, reports that disabilities are more prevalent among children from low-income families, with up to 20% of these children having a disability [
46].
5. Empirical Strategy
We used data on household members born between 1977 and 1997. As UPE started in 1997, household members born between 1991 and 1997 (0–6 years old in 1997) benefitted from the policy when they were in primary school or before enrollment. Thus, we defined people who were born between 1991 and 1997 as a UPE cohort (treatment group). For the control group, we considered two cohorts: a partial control cohort, which comprises people born during 1984–1990 (7–13 years old in 1997), and a perfect control cohort, which includes people who were born during 1977–1983 (14–20 years old in 1997). (The different generational backgrounds may lead to different household behavior. This problem appears as biases in parameters. To solve this bias issue, we adopted the DID based on the idea of regression discontinuity (RD) and controls for generational and regional characteristics utilizing fixed effects. Structurally, the results using the partial cohort are estimated by RD, and the results using the perfect cohort are estimated by DID.) To account for the possibility of delayed entry into school, two study cohorts were established. The “partial control” cohort represents the age group closest in age to that of the treatment group, but with the potential for delayed entry. Conversely, the “perfect control” cohort consists of individuals who are beyond the typical age of school entry and thus have an extremely low probability of experiencing delayed entry.
Figure 1,
Figure 2 and
Figure 3 show the mean values of three educational outcomes (years of schooling, enrollment rate, and completion rate) for non-PwDs and PwDs males and females, respectively.
Figure 1 indicates the change in years of education, and the values of non-PwD females and PwDs are at the same level in the perfect control cohort (aged 33–50 years).
In the partial control cohort, only females without disabilities showed increasing values, and their educational levels were almost the same as males without disabilities in the UPE cohort. We observed the same trend in enrollment (
Figure 2) and completion rate (
Figure 3).
We employed a DID estimation model as a basic identification strategy to identify the effects of the UPE policy on out-of-school children. We constructed three variables:
, which takes the value of one if a household member experienced the UPE policy when he/she was a primary student, and zero, otherwise;
, which takes one if a household member is female; and
, which takes one if a household member reported one or more disabilities, and zero, otherwise. (
takes one if the respondent answers option 3 or 4 for any of the six difficulties. The respondent who answers option 4 for any of the six difficulties is defined as severely disabled, as discussed in detail in
Section 6.2.)
We analyzed the effect of the UPE policy on educational outcomes using ordinary least squares (OLS) and logistic estimations as follows:
where subscripts
i,
j, and
t indicate respondent, region, and birth year, respectively.
is the educational outcome (years of schooling, primary enrollment, and primary completion).
is a vector for the characteristics of a respondent (
, type of residence, and wealth index) and household head (female, age, and years of schooling).
are the region and birth year fixed effects, respectively.
are the parameters to be estimated.
is an error term. The parameter of the interaction term between UPE and
Disability refers to the effects of UPE policy on PwDs, and the interaction term between UPE and
Female is the effect on females. These parameters allow us to test whether the UPE policy reduced the educational gap.
Table 1 presents the descriptive statistics for total samples.
Table 1 shows the characteristics of the respondents for the UPE and partial control cohorts. The female-to-male ratio was approximately 55%, and the ratio of having disabilities was approximately 4%. Respondents were about 25 years old on average, and 28% of respondents lived in urban areas. In terms of household heads, only 23% were female, and they had 7.4 years in school on average. The difference in mean characteristics in the UPE and non-UPE cohorts (Column (4)) indicates that, on average, the household heads of respondents in the UPE cohort tended to be female, and there were few differences in the rate of having disabilities.
Likewise,
Table 2 shows the main outcome variables (years of schooling, primary enrollment ratio, and primary completion ratio) for the UPE and control cohorts and for PwDs and non-PwDs. We tested whether any difference existed in the mean educational outcomes of both PwD and non-PwD respondents. In terms of all outcomes, regardless of the UPE policy, PwDs are less likely to be educated, compared to non-PwDs. However, after the UPE policy, both PwDs and non-PwDs had better educational attainments.
In addition,
Table 3 shows the same variables for gender. We can see that although educational outcomes for females increased significantly in the year of UPE implementation, they still did not meet the same level as their male counterparts. For male respondents, there was no clear change in any outcomes between the UPE and control cohorts.
7. Conclusions
In this study, we used a large and nationally representative 2016 DHS dataset from Uganda to compare the impact of the UPE policy on the years of schooling, school enrollment, and school completion rates of girls and children with disabilities. To estimate the effectiveness of UPE more systematically, we applied a DID model. Our results indicate that while UPE has been effective in reducing gender gaps in education, we could not observe the same level of impact on reducing gaps for PwDs.
We found that PwDs still face challenges in accessing UPE, and our results highlight that the UPE policy alone cannot increase enrollment, years of schooling, or completion rates for PwDs, in general, and girls with significant disabilities, in particular, without proper support provisions in place to accommodate their individual needs. Therefore, policy interventions with reasonable accommodation provisions, as stated in Article 2 of the CRPD, are required.
Furthermore, while UPE makes school fees free, families must still manage other costs, such as uniforms and educational materials, including textbooks. Negative income shocks resulting from these costs are likely to discourage families from sending their children with disabilities to school.
Our findings suggest that while UPE is an ambitious initiative, it cannot succeed without first identifying and addressing the difficulties that children with disabilities and their parents face. The lack of support provisions and inaccessible schools hinder the education of PwDs, who face difficulties when efforts fail to accommodate their individual needs by removing disabling barriers.
Therefore, our study highlights the need for complementary policy interventions, such as targeted subsidies including policy interventions lowering the credit constraints households face through a scholarship program and conditional cash transfers for poor families. However, strategies like these alone are insufficient to increase access for children with disabilities in school due to issues such as the inaccessibility of infrastructure. To address this, additional funding should be allocated to resolve the inaccessibility of infrastructure.