Disability-Inclusive Graduation (DIG) Programme — Northern Uganda

Northern Uganda faces intersecting challenges of ultra-poverty and disability exclusion; BRAC's long-running Ultra-Poor Graduation model — already replicated in 10+ countries — had not previously been explicitly adapted for people with disabilities.

Co-designed in 2017 by BRAC, Humanity & Inclusion (HI) and the National Union of Women with Disabilities of Uganda (NUWODU), the Disability-Inclusive Graduation (DIG) programme set out to adapt BRAC's Ultra-Poor Graduation model to explicitly include people with disabilities, testing whether disability-specific supports could improve health and economic outcomes for this population.

Across the Northern Ugandan districts of Kiryandongo, Gulu, Nwoya and Oyam, the 18-month programme combined unconditional cash transfers, livelihood asset transfers and training, savings-group access, and disability-specific supports (occupational, physical and psychosocial therapy; bi-monthly home visits; and community sensitisation) for 2,700 people living in ultra-poverty, at least 15% of whom had disabilities and 70% of whom were women.

A cluster-randomised controlled trial (370 intervention vs 321 control participants with disabilities, delivered December 2020–June 2022, followed up through October–November 2023) found no statistically significant reduction in overall illness or injury prevalence at either follow-up. It did find a statistically significant, progressively larger reduction in unmet health needs (adjusted odds ratio 0.4, p=0.002, at 16 months), alongside gender-differentiated effects: women in the intervention arm reported fewer injuries but more pain-related conditions than men.

The trial and its honest, mixed results have been published in a peer-reviewed journal, and BRAC has used the experience to produce a public 'Considerations for Implementing Best Practices' guide intended to help other organisations replicate or adapt the disability-inclusive approach elsewhere.