Interviews.

Key informant interviews were held with six leaders of GFD member organizations, namely: Ghana Association of Persons with Albinism, Ghana Blind Union, Ghana National Association of the Deaf, GFD representative, Sharecare Ghana and a sixth OPD that did not want to be identified But have members who have benefited from the DACF. In addition, eleven FMCs members from the eleven Assemblies were also interviewed. The Common Fund Secretariat was also contacted for interview. They however declined the interview and instead provided reports and other secondary information which have been incorporated in this paper. The GFD member organisations and FMC members will be referred to as ‘experts’ in this paper.

Key informants were chosen to include those directly responsible for the implementation and management of the Fund at the MMDAs levels. Leaders of OPDs who have traditionally led the advocacy around the DF were interviewed. Key Informants selection criteria at the MMDAs level included those directly handling the application process, those selecting beneficiaries, and those making allocation and disbursement decisions. Through purposive sampling participants were selected based on their involvement in either the implementation and/or management of the DF and leadership of OPDs that have traditionally led advocacy on and around the DACF.

Focus groups.

Five focus group discussions (FGDs) were conducted with 35 selected Fund beneficiaries of which 19 participants were males and 16 females. Three of the FGDs were organized in Municipal Assemblies and one in a District Assembly. Additionally, three of the FGDs (two Municipal and the District Assembly) comprised participants with various impairments, the fourth, only persons with physical disabilities and the fifth, consisted persons with hearing impairment from various MMDAs. To ensure that participants from the same disability groups were not overrepresented in the focus groups, lists of Fund beneficiaries were obtained from the MMDAs and the GFD representatives on the FMCs and those beneficiary lists were used to populate the focus groups. Focus groups were set up to include people with albinism, hearing impairment, Muscular sclerosis, physical disability, cerebral palsy and visual impairment. Beneficiaries who were successful with the Fund and actively engaged in livelihood generation activities, beneficiaries who were not successful or have yet to begin any livelihood generation activities, and applicants on the waiting lists were all included. Beneficiaries who were not associated with any disability groups were also included, because of the concern that only including people from disability groups would populate the focus groups only with people with the most support in accessing the funds. FGD participants included three persons with albinism, four persons with visual impairment, two persons with muscular sclerosis, two persons with cerebral palsy, nine persons with hearing impairment and 15 with other forms of physical disabilities. Out of these, four persons were on the waiting list and three beneficiaries did not belong to any disability association at the time.

Each of the four focus groups were 90 minutes long except for the one with persons with hearing impairment which lasted 125 minutes to accommodate interpretation time. On average, there were seven participants in each group. Interview and focus groups guides were used to standardize the information gathered among the various groups. Interviews were conducted in-person and online. Both interviews and focus group discussions were recorded, and key informants compensated for their data costs and for participants, transportation.

Ethical considerations. Letters detailing the purpose and objectives of the research were sent to the selected MMDAs and the GFD to seek permission to interview key informants. Written informed consents were taken from key informants before the interviews. Informants were requested to sign, thumbprint or grant consent for their assistants to write their initials on the written informed consent form. We emphasized that participation was voluntary, they were not obliged to answer questions they did not want to, and that no one was going to be identified [33].

There was no intervention or experimentation conducted as part of this analysis, only the participation in a focus group or interview. Before all those interactions, the purpose and use of the data was explained, as were assurances of confidentiality. Informed consent was obtained from all the participants, and no identifying information is included in this paper except direct quotations.

Knowledge of the program.

Persons with disabilities who participated in this study demonstrated significant knowledge of the existence of the program, the application process and following up on their applications. Knowledge of the program was gained in meetings of their various representative organizations, district sensitization meetings normally organized by the Community Development and Social Welfare Departments of the MMDAs, GFD outreach programs and workshops, assembly members and the electronic media.

As a result of the involvement of assembly members in disseminating information and civil society groups advocacy around the DACF for persons with disabilities, the general public is now aware of the program which helps persons with disabilities to access the program:

I used to sell things with someone and one day someone came to buy items and asked if I know that the government has support for persons like me? I said no, so the person introduced me to the assembly. (AA).

Application process and follow-up.

Closely related to beneficiaries’ awareness of the program is knowledge about the application process and follow-up, both of which beneficiaries were very familiar. Participants indicated that to apply for the funds, one needed to either write a letter or fill an assessment form from one’s MMDA. The assessment forms often have two sections: the first being personal information and the second, the purpose of funds being requested.

The application requires the applicant to indicate their name, contact number, house address, and then write whatever they are seeking for. The fund administrators don’t examine the construction of sentences and the like, just what the applicant is requesting. (TOR). For those who cannot read and write, the Social Welfare officers engage applicants and assist with the writing.

Quality of purchased items.

In 2018, Fund operations changed from distributing cash to in-kind items or equipment. This directive was a response to beneficiaries misapplying requested funds and going back to the assemblies for more support (Common Fund Secretariat Statement, personal conversation, 10^th March, 2022). However, other forms of challenges emerged affecting beneficiary experience. One of these is the quality of purchased items. Beneficiaries reported that sometimes the items or equipment they received, even though new, have been of very low quality or “not durable.” Most beneficiaries interviewed expressed great disappointment with what they received:

I also wanted a mixer. They called me that my item had been bought. But, when I collected and used it, then it makes sh-sh-sh noises. So as for that one, I have put it aside and I am still using my old one. I could not use that at all. You see, there is a smaller version of the mixer which is very good and that is what I wanted and even what they bought for me was too expensive. The one that I am telling you is very good, is not as expensive as what they bought for me. (GG).

I requested for drilling machine and sandpaper machine and they all broke down. Oh, when I even started using it, it didn’t last beyond one week it got broken. They didn’t buy quality products for me. It was something funny, it was just like a toy to play with. It wasn’t strong machine. (LT).

There was no beneficiary who did not have anything to say about the quality of purchased items. Even with those who were lucky enough to have received something good, knew others who had items that did not last.

It is true. I know a man who is a carpenter who received a chisel and the day he used it, there and then, it broke down. That first day, it blew off. But when he took it to the assembly they did not change it for him and he is still waiting for his replacement. (FM).

I know somebody who also received canopy to be renting out. The day the person started using the canopy, when the wind blew a little, all came down. The canopy stand all broke down. (TOR).

These beneficiary experiences were further corroborated by the OPDs leaders, and some FMC members interviewed. They had begun receiving complaints from some beneficiaries on the quality of items:

Even in relation to the purchasing of the items that some of us seem to be happy about is the quality of the items or the durability of the items purchased. So, if I said I needed a printer, a refrigerator or some capital intensive item, one of the complaints currently is that, they receive the item, but the item is of inferior quality, does not last or stand the test of time once they begin to put them to use. (E3) “S1 Table”.

Those things that the persons with disabilities need, it’s given to the procurement people, it’s like they want to buy the cheaper things. If the person is not able to tell the exact brand he or she wants, that means that person will be given any inferior item. So now we’ve let them know if you want may be a laptop, write the brand that you want. Maybe I want this I want that, if not, they will give you an inferior thing. (E8) “S1 Table”.

Procurement issues.

Another aspect of the quality challenge that came up in both the key informant interviews and the focus group discussions is the procurement process. When items and equipment go through procurement, they end up being too expensive. For example, ordinarily a freezer that should cost about GH₵2,500 would cost between GH₵3,500 or GH₵4,500 when it goes through assembly procurement procedures, further affecting beneficiary numbers and the quality of items. Expanding on this, experts and beneficiaries emphasized:

I think our major problem is the procurement because if I want to buy a freezer for someone, if I walk to the market to buy, it would be like GH₵1,400 or GH₵1,500. But then when it goes through procurements, then that means it is increasing to somewhere GH₵2,500 or GH₵3,600 which makes it very expensive. (E2). (See “S1 Table” for details).

Assemblies’ procured items were often highly priced and of low quality. When asked why Assembly purchased items were so expensive, an OPD leader on an FMC explained it was due to taxes:

When we question these things, they tell us that the procurement process makes the thing more expensive. For example, a wheelchair that should ordinarily cost 500 can cost 800 or more because they add certain taxes and the like. (UA). We also found Social Welfare Directors who are part of the FMCs interviewing and verting potential beneficiaries and their applications were not involved in the procurement. This results in people in charge of the procurement missing out on expert knowledge and insights when purchasing the items:

It is still with the procurement aspect. Because if we give out the list of items they need then that’s all. We have to sit aside and wait for the assembly to purchase. So we don’t have any say in the items they buy or whatever thing they will buy for the people; we don’t have any say (E8).

Additionally, some purchased items could not be used because they did not meet beneficiaries’ specific accessibility needs:

Later, some who also requested containers got booths. How can you move about in a small booth as a wheelchair user? How do you keep your items in that small enclosure? So, some people left theirs. About three or four were never claimed. The persons can’t use those. (UA).

Many people have got items they didn’t like or can’t even use. I went to the Social Welfare Director with TFA. To ask why we are sometimes given bad things like that. The Director said she has no hand in the purchasing of the items. But that there is a supplier who receives the cheque to purchase the various items. (SE).

There were reductions to requested items, equipment, and funds as well as not receiving the exact requested items. To reach many beneficiaries at a time, requested items were sometimes slashed. For example, some beneficiaries requested large poly tanks to retail water but received very small poly water tanks which do not help their work at all. Beneficiaries were very angry at receiving items and equipment short of expectations. Some beneficiaries also reported requesting 30 bags of maize for their corn dough business and ended up with 20 or 10 bags. The worrying aspect for the beneficiaries was, they were asked to sign for more bags of maize than they received. This we found was attributable to the procurement process as an Expert explained:

Because if somebody says they want to trade in provisions, or something else, you can’t use 1,000 Cedis, 1,000 of what provisions? What can it buy? You see, these things are going through procurement, so by the time they come, it would reduce and be like 400 Cedis worth of things. So 2,000 can be allocated to you but you will end up receiving items worth 400 Cedis (E12).

Other beneficiaries also reported getting freezers and items that were too small for their purpose. They wanted to store and sell fish, but then, very small fridges or deep freezers were bought for them. This resulted in some beneficiaries having to step down on their intended purpose of applying for the Fund:

I applied for a deep freezer and some cash to enable me buy chicken and tilapia to sell. Later when I was called to come for my items, I only received the fridge. When I asked them for the money, they said I should try and get the money for the tilapia and chicken. But I don’t have that kind of money for those things. I later decided to use the fridge to rather sell ice water. If I had received the money for the tilapia and chicken business would have been better than this ice water that I am selling now. (AM).

This woman also wanted to stock her shop and the following is what she got:

I applied for the DACF, and I requested for GH₵3000. And I wanted to sell diapers and sanitary pads. Yes, this was my proposal. And they invited me to come. When I got there, they just put one pack of baby diapers, sanitary pads, some few things one pack each and then they added GH₵100 to it for me. So, I asked them what am I going to do with this? These are things that I am going to sell but they are not something that I am going to use for myself. I refused to take them. But one of the officers of the Department of Social Welfare pleaded with me to take the items and that later she will call me to come back for a discussion or a top up. So later when I did the follow-up I went there and they gave me GH₵700. And rather they wanted publicity, they took a picture of me and then announced that yes, they have set me up and all that. Out of the GH₵3000 that I requested. (BB).

Again, in certain circumstances, the exact requested items were not purchased.

I have heard a lot of issues because I am the Regional Secretary, and it has been a challenge. If someone says I want a fridge may be the person has started from somewhere and then you change what they want. You know the fridges we have sizes, if I want 20 feet or whatever, they will go and change and buy me about 10 feet. It doesn’t help. Always you don’t send applications for them to give you exactly what you want to set you up. Always, they have to change what you send to them. The responses are also not fair. Sometimes they will tell you that, if you don’t like it leave it. (SJ).

This research found the FMCs normally want funds to reach as many beneficiaries as possible hence the reductions to requested items or funds. But beneficiaries in these focus groups preferred to receive significant help to make them self-reliant for long periods as echoed by this beneficiary:

When we went for the interview, they said we should use the funds for work and to stop begging. And the funds when they give us, you have to plan that this type of work is what I would want to do. But when you tell them the exact funds or thing you need for your business, they will not give you, but they will give you something small. (OC).

Disparity in allocations and lack of transportation support in some assemblies.

There is also a disparity in terms of the items that beneficiaries received. For instance, applicants who applied through or were recommended by MMDCEs, GFD representatives, Assembly members and FMC members were more likely to receive the exact requested items, including larger or more durable equipment, and multiple times than those who apply as ordinary persons. For example, if six people request for 2500-litter poly water tank, and two were not recommended or did not know any significant person, they would receive 800-litter poly water tank instead of the 2500-litter capacity originally requested. Speaking to this, an expert bemoaned:

So if there is a favoritism then it’s not from our office but from the GFD rep. Sometimes you get them interfering. This person, this person, or that person has this problem it’s urgent, do you deny the person the chance? So you see? But to the applicants they think that we are here and we have favorites. We are always taking care of everybody. But favoritisms don’t come from us. And then the political interference. You are here and then the Chief Executive will send, ten people. When you look at the ten people, they have all benefited before. May be last year, then, because the list is coming from Chief Executive, sister, what would you do? Would you tell him that you won’t take care of the people? So you see, these are some of the set backs (E11).

This practice was common in both performing and nonperforming assemblies and was not specific to any political party. Similarly, Ashiabi & Avea [26], Banks et al., [35], and Banks and colleagues [36], all assert that biases and differential treatments can affect program effectiveness and reach.

Also, there is no uniformity in the allocation process for example. Whereas some MMDAs assist beneficiaries with transportation cost when they claim their items, others do not. This created extra financial burden especially for those receiving bulky items and equipment. Failure to take into consideration additional costs and barriers experienced by persons with disabilities have also been noted by Walsham and colleagues [37].

Disability-specific issues.

Certain types of disabilities such as albinism were not recognized as a disability, making it harder for persons with albinism to access the Fund in some Assemblies. This expert asserted:

Yeah, for persons with albinism, it is not very easy for them to access in many of the districts. The reason being that some people still do not believe that persons with albinism are persons with disabilities. So, most times, the problem that comes out is that the money is for persons with disability but not for persons with albinism. So, there have been situations where we have to engage some Social Welfare Directors, who have been in the social work field for about 26 years. And they didn’t seem to understand the category of disabilities that they were dealing with. (E4).

Furthermore, people who are deaf experienced communication difficulties with FMCs and MMDAs staff. There were often no Sign Language Interpreters which resulted in Assembly staff either resorting to writing or using gestures which did not promote meaningful communication for persons who are deaf:

Communication is not easy it is difficult because for me when I went there, they didn’t invite a sign language interpreter to communicate with me. They asked me to write so they were communicating with me through writing. (MM);

You know, if you are talking in your own dialect, you see how you can express yourself. But then for people who are deaf, we have no speech. Many people also don’t understand the sign language. So even when you go to meetings, and you don’t even get a professional sign language interpreter, to be able to articulate the views of persons who are deaf to participant is difficult. You find out that a person who is deaf still has those problems of communication, and information. (E5).