Sources of evidence, pathways, and processes to support disability-inclusive decision-making in low- and middle-income countries: A scoping review

Widespread failure to sufficiently account for disability in policies and programming across sectors limits the inclusion of people with disabilities in global health and development strategies. These oversights are especially marked in low- and middle-income countries (LMICs), where 80% of the world’s 1.3 billion people with disabilities reside. To bridge disability policy and programming gaps, it is important to first understand how key categories of decision-makers think about disability in their work, including which sources of evidence, processes, and pathways they rely on to make policy and programming decisions about disability, and what influences (aside from evidence) shape their decision-making. To address these issues, we conducted a scoping review of the literature concerning the use of evidence in governmental and non-governmental decision-making around disability-inclusion in LMICs. We systematically searched databases of peer-reviewed literature and used thorough hand searches to gather grey literature. Documents were eligible if they focused on key governmental and non-governmental stakeholders; disability-inclusive or disability-related decision-making in mainstream or targeted planning, policy-making, programming, or evaluations; and were based on data from LMICs. All literature was double screened and extracted according to a standardised extraction sheet by four reviewers, working in pairs. We included 16 papers, with sources of evidence cited being highly variable and encompassing both empirical and experiential evidence, while barriers and facilitators to using evidence varied by evidence source. Outside of evidence, notable influences on decision-making included government legislation, power dynamics and involvement, stakeholder relationships, the local landscape, funding, and attitudes towards disability. This work highlights the barriers to, and enablers of, evidence utilisation in relation to disability, which can be targeted with intervention and advocacy. Moreover, this review suggests that supporting evidence-based decision-making in relation to disability in LMICs necessitates engagement with varied framings of evidence and influences on decision-making outside of evidence.