Employment and Participation in Meaningful Activities for Persons with Disabilities in Bhutan
Results from a National Survey

Executive Summary

Two Bhutanese men sitting in a library. One of the men is blind. They are sitting around a computer.

The Comprehensive Survey of Transition and Employment of Youth with Disabilities in Bhutan was conducted in late 2019, as part of a project on employment and meaningful participation of youth with disabilities in Bhutan titled, “Understanding, Developing, and Supporting Meaningful Work for Youth with Disabilities in Bhutan: Networks, Communities, and Transitions,” funded by the UK government and managed by the University of Minnesota Institute on Community Integration, Royal Thimphu College (Bhutan), and the University of Birmingham (UK). The survey was Phase One of the project and included 216 youth with disabilities (average age: 23) across 17 out of 20 dzongkhags [districts] in Bhutan. Fieldwork surveys and interviews were conducted in-person using Geographic Information Systems [GIS]-enabled technology. As with most things, delays were experienced and changes were made because of the COVID-19 pandemic.

Results from the survey were analyzed using exploratory factor analysis (EFA) in order to identify potential scales, predicators, covariates, and themes. The significant findings from the survey are the following:

  • The older a person with a disability is, the more likely they are to have a paid job and work a greater number of hours for pay.
  • Those youth with disabilities who took part in Technical and Vocational Education and Training (TVET) were significantly more likely to have a paid job and work a greater number of hours.
  • However, there was a significant negative relationship between the number of years in education and paid employment, indicating that the level of formal education the person with a disability experienced did not result in more work for pay.
  • The number of years of formal education did predict the likelihood of participation in meaningful social and community activities outside of paid employment.
  • If there was an availability of meaningful activities, youth with disabilities did engage in social and community participation.
  • Youth with disabilities who felt they were supported by their family members to seek or have a job were significantly more likely to be employed.
  • Significantly more persons with disabilities living in urban or semi-urban areas had more hours of paid employment than those living in rural and semi-rural regions.
  • Insignificant variables included number and level of disabilities, gender, and social stigma associated with disability characteristics.

The results of our survey suggest the following take-aways and suggestions for Bhutan, and similar low and middle-income countries:

  • Technical and Vocational Education and Training (TVET) is a significant factor in gaining paid employment and working a greater number of hours. Therefore, it is crucial for governments to invest in TVET for all youth and adults, but also to make TVET inclusive for all abilities.
  • Even though TVET was found to be significant for employment outcomes overall, just the number of years in formal education completed had a negative effect on the level of paid employment. This would suggest that the employment skills gained in formal education were either absent or misaligned for youth with disabilities, and in fact there was an economic ‘cost’ to being in school that was not compensated by future earnings. Therefore, it is important to better align formal education with employment and life skills and increase education’s socio-economic integration.
  • Family support was a significant predictor of employment and meaningful participation in Bhutan. It is important to support families in supporting their youth with disabilities, and to encourage high expectations for youth with disabilities.
  • There is a disparity in employment outcomes between urban and rural areas in Bhutan. While rural Bhutan may have more informal and non-wage socio-economic participation overall, it is important to invest in rural areas and provide contextually appropriate means for socio-economic opportunities.

 

Introduction

Globally, the most marginalized group when it comes to socio-economic participation and employment are persons with disabilities. Unemployment for persons with disabilities in nearly every country ranges on average from 80% to 90% (UN, n.d.). In the United States, the largest national economy in the world, only 30% of persons with disabilities aged 16-64 are employed (BLS, 2021). During the COVID-19 pandemic, persons with disabilities were hit especially hard. In the United States, 1 in 5 workers with disabilities have lost their job (NOD, 2020). Worldwide, the pandemic has significantly impacted persons with disabilities not only in employment, but also in access to health and basic resources (Humanity & Inclusion, 2020). This disparity has a significant impact not only on diversity and inclusion in societies and on the lives of persons with disabilities themselves, but also on national economies.

The presence and participation of persons with disabilities in economic development in low and middle-income countries (LMICs) has significant potential for positive socio-economic impact. It is estimated that access to vocational education and job training for persons with disabilities can generate wage returns of up to 20%, and their participation in the labor market can lead to aggregate total household gains of billions of dollars annually (Banks & Polack, 2015). The exclusion or limitation of the participation of persons with disabilities in national economies is estimated to significantly reduce productivity and tax revenue; and supporting greater economic participation of persons with disabilities would bring in more money than it would cost. Despite these promises, the relationship between disability, poverty, and inequality is significant (UNESCAP, 2018).

It is important to note that while we use the words ‘work’ and ‘employment,’ we do not necessarily mean only a wage-paying job with a private business or public entity. There is certainly a wide variety of activities in which humans engage upon that involve socio-economic participation – from home and family care that is often unpaid but nonetheless representative of household economic resources, to informal exchanges of goods and services, or labor and services in non-cash economies. In Bhutan, for example, a person with a disability that sweeps the grounds around a lakhang [Buddhist temple] may be compensated with food or other household goods; or a monk inside that lakhang may subside on the gifts of food from the surrounding community. These are not ‘jobs’ in a capitalist economic sense, but they nonetheless represent an exchange of labor or services for compensation. In other words, they are socio-economic participants. This is an especially important distinction to make in low and middle-income countries, where there are many examples of informal and non-cash-based economic relationships that often go unrecognized (Chen, 2007).

The project that produced this research report seeks to recognize the contextually appropriate and complex nature of socio-economic participation for persons with disabilities in Bhutan and also in other low and middle-income countries. In 2019, the University of Minnesota Institute on Community Integration, Royal Thimphu College (Bhutan), and the University of Birmingham (UK) initiated the project “Understanding, Developing, and Supporting Meaningful Work for Youth with Disabilities in Bhutan: Networks, Communities, and Transitions,” funded through a Global Challenges Research Grant by UK Official Development Assistance (ESRC ES/S004319/1). The project seeks to survey and share the current reality for inclusive employment and social participation for young adults with disabilities in Bhutan; provide advocacy, coordination, and interventions to support increased awareness and activity in this area; and also work towards sustained support and awareness for inclusive employment and social participation for young adults with disabilities around the world – particularly in countries with limited resources and that are significantly rural in nature.

This research report will present data and evidence from a comprehensive survey of youth with disabilities in Bhutan focused on employment and meaningful community participation. The project sought to investigate the extent to which young adults with disabilities in Bhutan are working for pay and are engaged in other meaningful activities, and what factors contribute to these two outcomes. The survey was conducted across the entire country of Bhutan, collected by Bhutanese field researchers in late 2019 via a Geographic Information System (GIS)-enabled questionnaire. A full account of the methodology is given in the next section following a brief description of the context of Bhutan. The research questions that guided this survey are given below.  

Research Questions

  1. What are the characteristics and environmental factors of people with disabilities who are working?
  2. What are the characteristics and environmental factors of people who are not working?
  3. What are the characteristics and environmental factors of people with disabilities who are engaged other meaningful activities?
  4. What are the characteristics and environmental factors of people who are not engaged in other meaningful activities?
  5. What community factors/employer (availability of employment, stigma, openness and capacity for employing people with disabilities) are significantly related to people with disabilities having paid employment?
  6. What family or community factors (living with family, type of Dzongkhag) mediate people with disabilities having paid employment?
  7. What community factors (availability of meaningful activities, stigma) are significantly related to people with disabilities being involved in other meaningful activities?
  8. What family or community factors (living with family, type of Dzongkhag) mediate people with disabilities being involved in other meaningful activities?

The Context of Bhutan

Bhutan is a small country located entirely in the Himalaya. The topography of Bhutan ranges from lowland jungles in the south that touch the Assamese plains of India, and then rising precipitously to the high Himalaya of the Tibetan plateau – topping out at 7,570 meters (24,836 ft). The population of Bhutan is just over 750,000 people (NSB, 2018).

Bhutan began the process of economic modernization into a planned capitalist economy with the First Five-Year Plan in 1959. In less than 100 years, Bhutan has made great strides in modern healthcare, education, and infrastructure. However, Bhutan is still relatively low in terms of development – ranking 129th in the Human Development Index (UNDP, 2020). Despite these economic indicators, Bhutan is well known for its alternative development philosophy of Gross National Happiness (GNH). In the late 1970s, the Fourth Druk Gyalpo [King] of Bhutan famously criticized economic indicators such as the Gross National Income in favor of a more holistic and sustainable focus on social, cultural, and environmental happiness. Since that time, the Bhutanese government has been working to operationalize this vision into its economic and social policies.

The conceptualization of ‘disability’ in Bhutan has transitioned into modern societal institutions such as education and healthcare. Before schools and hospitals existed, disability was conceived within a Buddhist worldview of karmic life-cycles of sin and rebirth, leading to a complex cultural attitude of pity and compassion. While these conceptualizations of disability in Bhutan are still quite relevant today, there has also been a syncretization of disability conceptualization with ‘modern’ views of medical pathology, social models, and human rights initiatives (Schuelka, 2015). In many ways, the conceptualization of ‘disability’ in Bhutan became more negative with the introduction of schools and access to healthcare that introduced social stratification and placed value on ability-sorting (Schuelka, 2018a).

Access to modern education for children with disabilities in Bhutan is a fairly recent phenomenon. This is especially true for children with severe intellectual and developmental disabilities. Discussing the issue, Schuelka (2013, p. 67) ascertained that these children were “marginalized and excluded.” This was also later confirmed by other research (e.g., Kezang Sherab, et al. 2015) that there were many out of school disabled children which is mainly attributable to parents’ unwillingness to send their children with disabilities to the schools, citing an unfriendly school environment such as a lack of individualized and accommodative curriculum, lack of trained teachers, and inaccessible infrastructure. The registration of people with disabilities in Bhutan 2015 found that 84.5% of the persons with disabilities have never attended a school or an institute. However, there has been a shift in the societal attitude and ways of thinking about disabilities as Bhutan is a signatory to the UN Convention on the Rights of Persons with Disabilities. The Ministry of Education has been closely working with the UN agencies such as UNICEF in creating education opportunities for the youth with disabilities. Recently, the Bhutan government also approved the holistic national policy for persons with disabilities with a vision “empowered persons with disabilities living in an inclusive society” (GNHC, 2019). With this policy in place, a lot of emphasis has been provided to improve the educational opportunities for youth with disabilities. For instance, Paro College of Education stepped up by offering a post-graduate program on inclusive education to prepare teachers who can take care of inclusive education in the schools. Furthermore, there are 22 Special Educational Needs (SEN) schools (at least one in each of the 20 Dzongkhags [districts]) that integrate children with disabilities into mainstream schooling, two specialized institutes (Wangsel Institute for the deaf and Muenselling Institute for the visually impaired, established in 1973), and two Draktsho vocational training centres with a total of 997 students (MoE, 2020). There are also many NGOs such as the Ability Bhutan Society (ABS), Draktsho Vocational Training Centres, Disabled Persons Organisation of Bhutan (DPOB), Bhutan Foundation, and Phensem who are instrumental in supporting the education of youth with disabilities. Despite these developments, recent research has shown that persons with disabilities face a number of challenges such as social stigma, cultural and religious beliefs, lack of resources, caregiver and teacher preparedness, and lack of awareness amongst the public (Dawa Dukpa, et al., 2021; Rinchen Dorji, 2015; Kezang Sherab, et al., 2015; MoE & UNICEF, 2017; Schuelka, 2018a; UNICEF, 2013).

Consistent to the global situation presented above, the economic and social participation of persons with disabilities is an issue in Bhutan. According to the latest Population and Housing Census of Bhutan, 2.1% of the population are categorized as disabled (NSB, 2020). However, using alternative forms of data collection using more of a functioning model, UNICEF (2015) finds there could be up to 20% disability prevalence in Bhutanese youth. If this is true, there would be significant number of Bhutanese with some form of disability. Mannocchi and Schuelka (2020, p. 2) also found that most persons with disabilities in rural settings are “isolated and inactive.” This is an indication that most persons with disabilities do not participate in economic and social activities and that they are dependent on their families and friends. Earlier research (Schuelka, 2015), as well as anecdotal evidence, also suggest that persons with disabilities are considered to be a burden in the family and believed that they cannot do any work for earning an income.

Bhutan has an overall unemployment rate of 5%, with 22.6% falling under the category of youth (15-24 years) unemployment (NSB, 2020). There is lack of data in terms of unemployment for persons with disabilities. Even the report on the Population and Housing Census of Bhutan does not mention anything about the unemployment rate of persons with disabilities. Such findings suggest that persons with disabilities are a marginalized group without adequate attention being provided to their health and well-being. However, recently there has been some attention on persons with disabilities with the help of UN agencies such as UNICEF and NGOs interested in promoting the health and well-being of persons with disabilities. For instance, the Draktsho Institutes (NGO) and Wangsel Institute for the deaf and Muenselling Institute for the visually impaired (Ministry of Education) have been providing some vocational skills to help persons with disabilities to find some gainful employment. With such support systems in place, the economic and social participation of the persons with disabilities is likely to improve in the near future

As mentioned above, Bhutan started officially recognizing persons with disabilities as early as 1973. Bhutan’s commitment towards persons with disabilities grew with the ratification of the Convention on the Rights of the Child in 1990 and Convention on the Rights of Persons with Disabilities in 2010. Consequently, the rights of the child have been also acknowledged in the Bhutan Building Rules of 2002; Labour and Employment Act of 2007, and the Constitution of Bhutan in 2008 (UNICEF, 2015). However, the first ever national policy for Persons with disabilities was launched only in August 2019 with a vision of “Empowered persons with disabilities living in an inclusive society” (GNHCS, 2019, p. 5). This policy framework is based on the following guiding principles: ‘non-discrimination, diversity and inclusiveness, disability mainstreaming, participation, and gross national happiness.’ With this policy in place, Bhutan may see a significant level of reduction in the discrimination and social stigma faced by persons with disabilities. This is also likely to take Bhutan forward in terms of meeting international commitments such as the ‘United Nations Sustainable Development Goals and UN Convention on the Rights of the Persons with Disabilities (UNCRPD).

This policy framework identifies policy interventions in critical areas such as in education (improving access to education, removing attitudinal barriers, early identification and intervention, and learning, assessment and examination); health (access to health services, prevention, early identification, intervention and rehabilitation, and healthy ageing); economic security (employment, support and enabling environment for business opportunities, awareness and advocacy); caregivers, families and communities (decision making, family/caregiver’s involvement in service provision, support for family and caregivers, and community); protection and access to justice; disaster risk reduction and mitigation; built environment; public transport; information, communication and technology (access, portrayal, depiction and use of persons with disabilities in the media); participation in cultural, spiritual, recreation, leisure and sport activities; policy and planning; political participation; finance; human resource and capacity development; support and collaboration with NGOs/CSOs/DPOs; and data and information management. For the time being, until such a competent organization has been identified, the Gross National Happiness Commission Secretariat will be the lead agency to coordinate all disability-related policy, plans and programs.

Methodology

The survey featured in this research report was conducted in the Kingdom of Bhutan [Druk Gyal Khap] between June and October 2019. Data collection for this study was coordinated by the Royal Thimphu College and spanned across 17 out of 20 Dzongkhags [districts] covering all regions of Bhutan – from rural to urban, and the sub-tropical foothills to the sub-alpine tundra of the Great Himalaya. Ethical clearance for the survey was given by the Bhutanese National Statistics Bureau (NSB/SDPD/Survey/2019-20/4870), as well as the University of Birmingham Research Ethics Office (ERN_18-1601).

Survey participants included 216 young adults with disabilities, of whom 59% male and 41% female. According to the Bhutanese National Statistics Bureau (2018), the total disabled youth population (age 16-24) is approximately 880 people. The National Statistics Bureau now uses the Washington Group (2021) functioning classification system to determine disability characteristics, and we have also employed and adapted the Washington Group scales in our own survey.  On a scale from 1 (no difficulty) to 4 (cannot do it at all) assessed across different areas, including physical, cognitive, social, communication, and adaptive behavior, the average level of difficulty was 1.8.  The average number of difficulties on a scale from 1 to 10 was 4.7. Most participants were able to respond to the interview questions themselves (80%), while proxy responders, usually their family members, answered on behalf of 20% of participants who were not able understand and/or answer the questions due to their disability. The majority of the participants lived with their family (77.8%) and were not married (86.9%). Only 18.5% of participants received any financial assistance because of their disability. 32.9% of participants in the sample were currently attending some type of education program. Of the remaining 143 (67.1%) not in school, 76 reported that they had not completed even 1 year of schooling. All participants took part in this study on a voluntary basis with no incentives provided for their participation. The approximate number of participants per Dzongkhag can be seen in Figure 1 below, indicating areas with both higher populations as well as higher participation in the survey. There are more persons with disabilities in urban and semi-urban areas of Bhutan such as Thimphu and Phuentsholing (Chhukha); as well as the more populated rural and semi-rural Dzongkhags of Samtse, Monggar, and Trashigang. This could be simply that there are more people living in these areas and thus would naturally have a higher population of persons with disabilities but could also indicate that persons with disabilities – and their families – have migrated to more populated areas because of access to social services and opportunities for both themselves as well as family members with disabilities. We note that in our survey, we asked participants about their Dzongkhag that they ‘call home,’ which may not necessarily align with where they currently (or temporarily) live. In Bhutan, although many people increasingly may migrate to urban areas to seek economic and social opportunities, they still consider their ‘home’ community to be where their family (and ancestors) have traditionally resided. A visual representation of the distribution of the population of Bhutan is provided for reference in Figure 2, displaying only the Dzongkhags represented in this survey. [1]

Figure 1. Map of Bhutan with Number of Survey Participants per Dzongkhag

A map of Bhutan divided into districts (Dzongkhags). The map shows the approximate number of participants per Dzongkhag. Areas with both higher populations as well as higher participation in the survey. There are more persons with disabilities in urban and semi-urban areas of Bhutan such as Thimphu and Phuentsholing (Chhukha); as well as the more populated rural and semi-rural Dzongkhags of Samtse, Monggar, and Trashigang.

Figure 2. General Population Map of Bhutan (Only Survey Dzongkhags)

A map of Bhutan divided into districts (Dzongkhags). The map shows a visual representation of the distribution of the population of Bhutan. The western part of Bhutan has the largest population.

Survey Instrument

The Comprehensive Survey of Transition and Employment of Youth with Disabilities in Bhutan was developed by researchers at the University of Minnesota Institute on Community Integration in collaboration with faculty, researchers, and staff at the University of Birmingham (UK) and the Royal Thimphu College in Bhutan. The purpose of the survey was to capture the current situation (facilitators and barriers) of employment, other paid and unpaid work, and engagement in other meaningful activities for young adults and adults with disabilities in Bhutan. The survey included a demographics section, followed by sections on the experiences of young adults with disabilities with transition from school to employment, their experiences with attitudes of the community, and their level of support of family and employers to them working or participating in other meaningful activities.

Survey development was based on the project research questions, a thorough review of the literature on employment and participation in other meaningful activities of people with disabilities with a focus on measurement, and a series of meetings between investigators and Bhutanese project staff. Once a series of initial survey items had been developed, they were vetted by a technical expert panel (TEP) composed by US, Bhutanese, and UK project staff to establish their content validity with special attention to cultural and contextual appropriateness. The majority of existing employment surveys are based on countries with large urban populations and a high percentage of individuals engaged in commercial business activities, so we needed to develop a bespoke and contextually appropriate survey. There were 12 items related to demographics and personal characteristics, and 78 items related to the participants experience in society related to their disability.

To provide some population context, in Bhutan nearly half of the population are engaged in the agricultural sector as a means of employment, and in the rural areas nearly two-thirds of the population are engaged in agriculture. Nearly 40% of the population of Bhutan live in an urban area – primarily in the capital of Thimphu, and also the border trading town of Phuentsholing (NSB, 2018). Labor statistics in Bhutan also exclude a wide variety of people in its accounting, as the National Statistics Bureau removes nearly 37% of the work-age population from its counting and labels them as ‘economically inactive.’ Those that are deemed ‘economically inactive’ include persons with disabilities. Based on TEP suggestions, the investigators held a series of discussions with project staff and items were refined to ensure that they reflected the Bhutanese context. Although the survey was not formally piloted prior to use, it was vetted by a number of individuals and local organizations familiar with the current employment status and engagement in other meaningful activities of people with disabilities in Bhutan. 

The survey was administered by trained project staff as a structured in-person interview using iPads to immediately enter all data. The iPads were fitted with SIM cards and all data was instantaneously uploaded to a secure online server via mobile data. The survey was GIS-enabled and used the ESRI Survey123 app and online platform.

Procedures

Participant recruitment. A participant recruitment plan was developed by the project team with special attention to the Bhutanese geographical terrain, knowledge of where people with disabilities live, and representation of people’s perspectives across all regions of the country. The list and contacts of potential survey participants was initially based on information provided by several civil society organizations, government entities, and individual contributions. These are acknowledged at the end of this report. Based on the list of young adults with disabilities provided by these organizations, research assistants (RAs) from Royal Thimphu College made telephone calls to locate the participants and sought their consent to be interviewed. However, knowing that some potential participants might not be included on the list provided, an additional snowball sampling technique was employed. This approach involves participants recruiting other participants for a test or study through their own professional and social connections. It is often used where potential participants are difficult to identify. In Bhutan, this approach to participant recruitment is especially valuable as many people with disabilities live in mountainous remote areas and not necessarily known to all authorities. Bhutan is also a small country with robust community and social networks. Current participants were not provided with any incentives/compensation to reach out to other persons with disabilities who might be interested in taking part in the study. Based on information gathered from local leaders and listed participants, additional participants were located and interviewed. 

Most participants contacted agreed to be interviewed. There were 12 parents and individuals with disabilities who did not consent to being interviewed. They did not feel comfortable with the process due to the personal nature of the survey topic or because of communication barriers. In some cases, their parents shared their reservations about interviewing and participation, citing the social stigma attached to disability and the individual’s uneasiness in sharing stories about their disabilities and challenges.

Training of data collectors. The initial training of data collectors took place over three days in 2019 at the Royal Thimphu College (RTC) when the project team visited Bhutan, and the training was conducted by the lead project staff with extensive experience in survey research. The training provided an overview of the tool structure, including types of questions and response options, obtaining participant consent, interviewing approach, data recording using iPads, etc. Interviewers then practiced mock interviews under the supervision of experienced project staff and were provided with extensive feedback about their interviewing technique. A four-hour follow-up session was conducted with interviewers to ensure that they were comfortable using the data entry technology-based application used for the interviews.

Data collectors included five research assistants that were academic faculty members from RTC, and field staff for data collection also included two Bhutanese co-investigators from the project staff. The research assistants from RTC were relatively junior academic faculty or were new to social science research. Four out of the five research assistants were Bhutanese, with the fifth being an Indian national with over a decade of residency in Bhutan. All field staff – research assistants and co-investigators – were fluent in the most common languages of Bhutan: Dzongkha, Tshangla (Sarchop), and Nepali.

Data collection. Data collection in this project was more challenging than in a typical survey research for several reasons. One of these was communication. In addition to communication barriers resulting from the disabilities of participants, the languages of Bhutan are quite localized. Although Dzongkha is the official language of the country, and English is the language used in education, Bhutan is linguistically rich with over nineteen languages spoken. This richness can at least partially be attributed to the geography of the country with its high mountain passes and deep valleys. In addition, although deaf citizens in Bhutan use a form of Dzongkha sign language, this system of non-verbal communication is still under development and there is a lack of qualified interpreters. Communication issues encountered by data collectors included questions regarding the accuracy of understanding some participants and the fact that in a country in which social ties are considered to be a great importance, data collectors had limited to no exposure to the youth and adults with disabilities they were interviewing prior to survey visits. It should be noted that in almost all cases, data collectors were able to meet the communication needs of participants.  The project was fortunate in having data collectors who spoke multiple languages – a very common attribute in Bhutan. In addition, when it was clear that a specific language was likely to be the only one through which a participant could communicate, an interviewer who spoke that language was assigned to conduct that interview.

Access to survey participants was a second challenge that needed to be overcome. Bhutan is located in the eastern Himalaya and is therefore both mountainous and heavily forested. The country has a dry and a monsoon season. During the monsoon season with heavy rains, many roads erode and landslides are frequent. In addition, there are no roads to many parts of the country in the high mountains. As the survey was conducted during a peak monsoon season in Bhutan, access to most places located far away from highways were not possible. Therefore, data collectors interviewed some participants after they left for their schools or training institutes, resulting in taking alternative approach to observing and interviewing participants in their learning, rather than home, environments.

The survey was administered as an in-person interview using iPads.  Data collectors began each interview by engaging participants in an informed consent process, followed by the collection of demographic information and the survey itself. While the interview was structured, the whole interview process was conversational, allowing the data collectors to familiarize themselves with the person, and in many cases their family, before asking specific questions.

Data Analysis

Tables 1, 2, and 3 below provide a summary of three types of variables, predictors, covariates and outcomes, used in the analyses. The variables were purposefully selected based on the research questions and after examining their distributions (e.g., skew) and correlations with other variables (e.g., in the case of the scales).

The proposed analysis included descriptive analysis of all variables, followed by exploratory factor analyses (EFA), descriptive analysis of variables included in the inferential analyses, included combined and created variables, linear regression for employment outcome (continuous) and a logistic regression for other meaningful activity outcome (binary) to answer the outlined research questions. Descriptive statistics (i.e., means, range of scores, missing data, etc.) guided the creation of composite and scale variables entered into inferential analyses out outcomes. All analyses were computed using the IBM SPSS statistics software, version 25.

There were four variables included in the analyses based on individual survey items. These included items focused on age, gender, family attitudes toward engagement in meaningful activities, and participation in meaningful activities. The remaining variables included in analyses were created either by combining survey items into a more comprehensive or meaningful variables (e.g., Type of Dzongkhag was organized on a continuum from urban to rural) or by conducting exploratory factor analyses (EFA) to empirically create variables at the scale level.

There were two categories of predictor variables included in the analyses, the personal characteristics of participants with disabilities (e.g., age and level of education) and environmental characteristics specific to employment and participation in meaningful activities of people with disabilities in Bhutan. We also included two covariates hypothesized to have an impact on the studied outcomes, living with family vs. with others and living in a urban or rural Dzongkhag.  The two primary outcomes of interest in this study were the extent to which the person with a disability is working for pay and to whether they are engaged in any meaningful activities in the community.

Table 1. Predictors

Variable name

Variable label

Variable type

Personal characteristics

Disabiltynumberaverage

# of difficulties x (multiplied by) average level of difficulty

Ordinal (created variable)

Age

Age

Scale

Gender

Gender

Nominal

Education

Years in education or currently in education

Ordinal (created variable)

SchAtt8

Are you currently, or have you ever, participated in technical vocational education and training (TVET), zorig chusum training (official or unofficial), or other types of job and work skill trainings? (Employment outcome only)

Nominal

Environmental charateristics

EA4Availability

Scale Availability of employment (Employment outcome only)

Scale (based on FA)

MO1Availabilityofmeaningfulactivities

Scale Availability of meaningful activities (Meaningful activity outcome only)

Scale (based on FA)

FA1Familysupport

Scale Family support for employment (Employment outcome only)

Scale (based on FA)

FA2 Familyencouragement

Family encouragement for working at home (Employment outcome only)

Scale (based on FA)

Family Attitude

Does your family encourage you to spend time in the community doing activities you enjoy/find meaningful? (Meaningful activity outcome only)

Single question

EA1Openness

Scale Openness to hiring person with disability (Employment outcome only)

Scale (based on FA)

EA2Employercapacity

Scale Employer capacity to support employees with disability (Employment outcome only)

Scale (based on FA)

EA6Opennessofemployers

Scale Openness of employers to support people with disabilities working (Employment outcome only)

Scale (based on FA)

EA5Disabilitystigma

Scale Disability stigma (Both outcomes)

Scale (based on FA)

Table 2. Covariates (mediators/moderators)

Variable name

Variable label

Variable type

Mediators

LiveWithFamilyOther

Living with family (any family) vs. with others

Nominal (created variable)

Dzongktype

Dzongkhags by urban, semi-urban, semi-rural and rural

Scale (created variable)

Table 3. Outcomes

Variable name

Variable label

Variable type

HoursWorktotal

Combined variable working for money (yes, no, student) and how many hours per week working (Employment outcome)

Scale (created variable)

DoAct

Are you currently taking part in any meaningful, interesting, enjoyable, valued, or inspiring activity (other than employment)? (Meaningful activity outcome)

Nominal

Development of scaled environmental predictor variables using exploratory factor analyses (EFA)

In order to make meaningful predictions about employment and engagement in meaningful of young adults with disabilities in Bhutan, one of the first steps was to conduct an exploratory factor analyses (EFA) using items specifically developed to address employment and meaningful activities outcomes. Although items were developed to specifically address the outcomes of interest and their related predicators and covariates, subscales were originally clustered based on thematic topics, rather than empirically. As a result, we opted for EFA to identify potential scales for later use based on data. Maximum Likelihood was used as the extraction method and Varimax with Kaiser Normalization for factor rotation. Table 4 includes the scales’ characteristics in the form of number of original items, internal consistency (Cronbach’s alpha), mean score combined from individual items and the number/percentage of participants included in calculating the properties of each scale.

Table 4. Scales created based on EFA

Scale name

# of items

Cronbach’s Alpha

Mean/SD

N/%

EA1 (Openness to hiring person with disability)

7

.87

12.29 (3.42)

200 (92.6)

EA2 (Employer capacity to support employees with disability)

6

.87

10.41 (2.99)

198 (91.7)

EA3 (Employee willingness to build disability awareness at work)

3

.88

5.60 (1.80)

204 (94.4)

EA4 (Availability of employment)

5

.79

7.54 (2.07)

202 (93.5)

EA5 (Disability stigma)

5

.75

9.62 (2.47)

201 (93.1)

EA6 (Openness of employers to support people with disabilities working)

4

.79

7.93 (2.29)

199 (92.1)

T1 (School preparation for adulthood)

10

.92

21.58 (7.03)

121 (56.0)

T2 (School preparation for employment)

4

.90

6.82 (3.31)

125 (57.9)

FA1 (Family support for employment)

5

.85

10.74 (3.96)

201 (93.1)

FA2 (Family encouragement for working at home)

6

.84

12.17 (3.72)

193 (89.4)

MO1 (Availability of meaningful activities)

2

.92

3.78 (1.42)

205 (94.9)

It is important to note that all scales reflect participants’ views about the issues that may be different from those of employers (report forthcoming) or other community members.

As the results in Table 4 indicate, all scales demonstrated very good or good internal consistency, regardless of the number of items. Scales addressing school preparation (T1 and T2) could only be calculated using participants who had experienced schooling. The scale addressing disability stigma (EA5) demonstrated the lowest internal consistency and is different from the other scales in that it is framed negatively. These scales were used in both inferential analyses addressing the employment and participation in a meaningful activity outcome.

Results

Descriptive Statistics

Tables 5 and 6 below provide descriptive information in the form of mean scores, standard deviations, in some case frequencies and percentages as well as the number of participants in the analysis for the employment and participation in meaningful activities outcomes. Each variable is labeled based on their function in the analysis.

Table 5. Descriptive statistics for employment outcome

Variable Type

Variable Name

Mean

SD

N

DV

Number of hours working for money

11.40

21.93

202

IV- personal

Number of difficulties and average level of difficulty

9.61

7.25

202

IV - personal

Age

22.49

6.28

202

IV - personal

Gender (1 = M, 2 = F; 3 = other)

1.41

0.49

202

IV - personal

Years in education or currently in education

1.87

1.72

202

IV - personal

Participation in technical vocational education and training (TVET), zorig chusum training (official or unofficial), or other types of job and work skill trainings (yes = 1, no = 2)

1.71

0.45

202

IV - environmental

Scale: Availability of employment (5 items)

1.51

0.42

202

IV - environmental

Scale: Disability stigma (5 items)

1.94

0.51

202

IV - environmental

Scale: Family support for employment (5 items)

2.13

0.79

202

IV - environmental

Scale: Openness to hiring person with disability (7 items)

1.74

0.49

202

IV - environmental

Scale: Employer capacity to support employees with disability (6 items)

1.73

0.50

202

Covariate/Mediator

Living with family (= 1) vs. with others (= 0)

0.78

0.41

202

Covariate/Mediator

Type of Dzongkhag (urban = 1/rural = 4)

2.43

1.00

202

Note. DV = dependent variable; IV = independent variable

As can be seen in Table 5, the average number of hours participants worked were 11.4.  The standard deviation (SD), however, is larger than the mean, indicating a large difference between hours worked, including 67.6% of participants who did not work for money at all. The average age of participants was 22.5 years (young adults), and there were more males in the sample than females by approximately 20%. The average number of years participants attended school was approximately 2. The SD was almost as high as the mean value, suggesting considerable variability. It is also important to note that approximately 55% of participants indicated they have not attended any formal schooling at all, which deflates the number of years in school of those who did attend. The majority of participants (approximately 70%) did not take part in any vocational or other job-related training. Participant scores on all scales reflects an averaged mean value across the items included in each scale. There were significantly more people living with family than with others by approximately 55%. Most participants lived in semi-rural areas (38%), while the least in rural areas (14%). Twenty-four percent of participants lived in urban areas and approximately the same percentage in semi-urban areas.

Table 6. Descriptive statistics for meaningful activities outcome

Variable Type

Variable Name

Response

Frequency/Mean

Percentage/SD

N

DV

Taking part in any meaningful, interesting, enjoyable, valued, or inspiring activity (other than employment)?

Yes

123

60.80

203

IV- personal

IV- personal

Number of difficulties and average level of difficulty

Numeric

9.61

7.25

203

IV- personal

Age

Numeric

22.49

6.28

203

IV- personal

Gender

Male

120

59.30

203

IV- personal

Years in education or currently in education

Numeric

1.87

1.72

203

IV - environmental

Scale: Availability of meaningful activities (2 items)

Numeric

1.89

0.71

203

IV - environmental

Does your family encourage you to spend time in the community doing activities you enjoy/find meaningful?

Yes

134

65.90

203

IV - environmental

Scale: Disability stigma (5 items)

Numeric

1.94

0.51

203

Covariate/Mediator

Living with family vs. with others

With family

158

77.80

203

Covariate/Mediator

Type of Dzongkhag (urban/rural)

Urban, semi-urban, semi-rural,  rural

50, 47, 80, 26

24.6, 23.2, 39.4, 12.8

203

Note. DV = dependent variable; IV = independent variable

The dependent variable (outcome) described in Table 6 was a binary variable, a single question in the survey, asking whether person has participated in any meaningful activities in the community, other than employment. About 60% of participants responded positively. Out of the other variables in the equation, several were the same (with almost identical distributions) as in the case of employment (i.e., number and level of difficulties, age, gender, number of years in school, scale: Disability Stigma, living with family, and type of Dzongkhag). In the analysis of participating in meaningful activities, we included another scale: Availability of Meaningful Activities composed of two original items. We also included a single question about family encouragement to participate in meaningful activities in the community. Sixty-six percent of participants expressed they were encouraged by their family members.

It is important to note that some variables in Table 6 were reported as frequencies with a corresponding percentage value (e.g., gender and living with family), while others were reported as mean scores with corresponding standard deviations (e.g., age and number of years in education).

Inferential Statistics

Table 7. Linear regression for employment outcome

Variable

Unstandardized coefficient ß

Coefficient standard error

Standardized coefficient ß

t

Sig.

Number of difficulties and average level of difficulty

-0.31

0.22

-0.10

-1.43

0.16

Age

0.82

0.23

0.23

3.61

0.00

Gender

1.94

2.73

0.04

0.71

0.48

Years in education or currently in education

-1.59

0.90

-0.13

-1.78

0.08

Participation in technical vocational education and training (TVET), zorig chusum [2] training (official or unofficial), or other types of job and work skill trainings

-8.14

3.20

-0.17

-2.55

0.01

Scale: Availability of employment

0.73

4.05

0.01

0.18

0.86

Scale: Family support for employment

7.86

2.16

0.28

3.64

0.00

Scale: Openness to hiring person with disability

Scale: Employer capacity to support employees with disability

0.52

3.54

0.01

0.15

0.88

Scale: Disability stigma

-3.77

2.64

-0.09

-1.43

0.16

Living with family vs. with others

-2.28

3.67

-0.04

-0.62

0.54

Type of Dzongkhag (urban/rural)

-4.63

1.39

-0.21

-3.33

0.00

We used linear regression to analyze the continuous variable of employment to investigate the extent to which predictors and moderating variables have a significant impact on the number of hours people with disabilities work for pay in Bhutan. As can be seen in Table 7 above, there were several variables significantly associated with working more hours for pay: age, years of education, participation in technical or vocational education and training, family support for employment, and the type of Dzongkhag where the participant lived. Results indicated that the older a person is, the more likely they are to work a greater number of hours for pay. Those participants who took part in technical or vocational education and training (TVET) were significantly more likely to have a paid job and work a greater number of hours. However, there was a significant negative relationship between the number of years in education and paid employment, indicating that the level of formal education the person with a disability experienced did not tend to result in more work for pay. In other words, while participants found increased employment through participation in TVET, the number of years of school itself did not increase participation in employment. In fact, we found that the more the number of years of school the less participation in employment persons with disabilities experienced. This may seem surprising, but in Bhutan this is being experienced by all youth both with and without disabilities (NSB, 2018). Participants who felt they were supported by their family members to seek or have a job were significantly more likely to be employed. Lastly, more people living urban or semi-urban areas had more hours of paid employment than those living in rural and semi-rural regions. This can be seen in Figure 3 below, in which the availability of employment, openness of employer to hire a person with a disability, and capacity to support a person with a disability in employment are aggregated and then divided by the attribute of the Dzongkhag (urban, semi-urban, semi-rural, rural).

Figure 3. Significant Predictors of Employment Outcomes

A flow chart showing the significant predictors of employment outcomes. Employment is at the center and surrounding employment are 4 significant predictors: urban region, family support for employment, participation in technical or vocational education, and older age. Employment does not equal participation in formal education.

Figure 4. Employment Outcomes for Persons with Disabilities in Bhutan, by Dzongkhag Attribute

A map of Bhutan divided into districts (Dzongkhags). There are differing shades of blue. The darker the blue, the more employment opportunities and outcomes exist. The darkest areas also match the more urban areas in Bhutan: Thimphu, Chhukha (the second largest city, Phuentsholing), Sarpang (the border/trade towns of Sarpang and Gelephu), and Samdrup Jongkhar (the border/trade town of the same name).

In Figure 4, the darker the blue the more employment opportunities and outcomes exist, according to participants in our survey. The darkest areas also match the more urban areas in Bhutan: Thimphu, Chhukha (the second largest city, Phuentsholing), Sarpang (the border/trade towns of Sarpang and Gelephu), and Samdrup Jongkhar (the border/trade town of the same name). 

The other variables in the equation were not significant, including the number and level of disabilities, gender, other scales (except for Family Support for employment) or living with family. These results are an indication that the non-significant variables had less explanatory power than the significant variables because of their focus (content) and the way the questions addressing a certain construct were conceptualized.

The total variance explained by the variable in the equation examining the continuous outcome of employment was 29% (R2 adjusted), which represents a moderate effect size.

Table 8. Logistic regression for meaningful activity outcome

Variable

Regression coefficient ß

Coefficient standard error

Wald's X2

df

Sig

eß (odds ratio)

Number of difficulties and average level of difficulty

-0.03

0.03

0.85

1.00

0.36

0.97

Age

0.03

0.03

0.74

1.00

0.39

1.03

Gender

0.13

0.37

0.12

1.00

0.73

1.14

Years in education or currently in education

0.26

0.12

4.99

1.00

0.03

1.30

Scale: Availability of meaningful activities

1.07

0.31

12.18

1.00

0.00

2.91

Question: Does your family encourage you to spend time in the community doing activities you enjoy/find meaningful?

1.76

0.39

20.89

1.00

0.00

5.82

Scale: Disability stigma

-0.55

0.40

1.85

1.00

0.17

0.58

Living with family vs. with others

0.59

0.52

1.29

1.00

0.26

1.80

Type of Dzongkhag (urban/rural)

0.21

0.18

1.28

1.00

0.26

1.23

Note. DV = taking part in a meaningful activity (other than employment); N=203

To examine the binary outcome of participation in a meaningful activity other than employment, we utilized logistic regression to investigate which predictors and moderating variables had a significant impact on whether or not a young adult with disabilities in Bhutan participated in meaningful activity(ies) other than employment. As shown in Table 8, several variables were significantly positively associated with the outcome of meaningful activity. These included: number of years of education, availability of meaningful activities, and family encouragement for engaging meaningful activities in the community. People with disabilities who experienced encouragement from their family members, had activities available in their community and more years of education were more likely to participate in a meaningful activity(ies).

The remaining variables did not significantly contribute to the explanation of the outcome of meaningful activity, including the number of level of disabilities, age, gender, perceived disability stigma, living with family or with others, and the region where the person lived. In Figure 6 below, the meaningful outcome variable was divided by Dzongkhag attributes (urban, semi-urban, semi-rural, rural). While not statistically significant as a predictor variable, nonetheless it be seen that, again, the more urban or semi-urban the Dzongkhag, the more the survey participants experienced meaningful activities and outcomes in general society.

Figure 5. Significant Predictors of Participation in Meaningful Activities

A flow chart that shows the significant predictors of participation in meaningful activities. At the center of the flow chart is participation in meaningful activities with 3 significant predictors surrounding it: number of years in education, family encouragement, and availability of meaningful activities.

Figure 6. Meaningful Activities and Outcomes for Persons with Disabilities in Bhutan, by Dzongkhag Attribute

A map of Bhutan divided into districts (Dzongkhags). There are differing shades of blue. The darker the blue, the more urban or semi-urban the Dzongkhag, the more the survey participants experienced meaningful activities and outcomes in general society.

The total variance explained by variable included in this model in explaining the participation in a meaningful activity was 33% (Cox & Snell R2), which represents a moderate effect size. The largest odds ratios in the case of individual variable entered into the regression was family encouragement for participation in meaningful activity, followed by availability of meaningful activities (refer to Table 8).

Results Summary

To summarize, the results have showed that there are more people with disabilities engaged in meaningful activities than working for pay in Bhutan as indicated by this sample. In the case of the employment outcome, people who were older, participated in technical and vocational education and training, experienced family support for employment, lived in more urban areas, and had less formal education and were those who worked at all or worked more hours in their jobs. In the case of participation in a meaningful activity, only people who experienced encouragement from their family members, had activities available in their community, and had more years of formal education were more likely to participate in meaningful activity(ies).

Discussion and Conclusion

Expectations, Values, and Preferences of Socio-Economic Participation

The overall expectations for persons with disabilities are low in Bhutan, and families often seek to ‘protect’ their youth with disabilities from engaging in hardships that they perceive to be ‘beyond their abilities’ (Karma Jigyel, et al. 2020; Schuelka, 2015). In Bhutanese culture, there is not an expectation of independence and individual responsibility for subsistence, as there might be in a context such as the United States, so there is little social stigma in terms of living at home and not engaging in socio-economic activities. However, this is not to negate the importance of socio-cultural participation and engagement of personally meaningful activities that all persons with disabilities in Bhutan should be supported in achieving. There is also a societal shift occurring in Bhutan as a human rights discourse promotes more individual determination and participation in education and socio-economic sectors. This is clear from our survey in that family support for socio-economic participation of their youth with a disability was statistically significant factor in increasing that participation.

The various lived-experiences and expectations of persons with disabilities in Bhutan is in sharp focus when observed the differences between urban and rural experiences. As found in our survey, there are more opportunities for socio-economic participation of youth with disabilities in urban areas, as opposed to rural areas, at least in the sense of meaningful paid employment. The availability of meaningful activities remained the same between rural and urban areas, most likely because meaningful activities in Bhutan are explicitly cultural in nature and are conducted throughout Bhutan such as religious rituals and festivals, dances, music, traditional arts and crafts; and sports such as dhatse [archery], dego [stone throwing], and khuru [lawn darts]. However, as was discussed earlier in this report, there is much economic activity in Bhutan that is not necessarily captured in economic statistics and Global North-conceived notions of economic wage and employment participation. In rural Bhutan, economic activity is primarily agricultural, with many families producing food merely for their own subsistence with some small cash-cropping to earn a bit of extra money to support the household. Urban Bhutan represents an economy in the capitalist sense where earning a wage for services is crucial for living. There are more opportunities for youth with disabilities in urban areas for wage employment in the service sector. Overall youth unemployment in Bhutanese urban areas (33%) is double that of urban areas (15%) (NSB, 2020), which reflects the bifurcated nature of the Bhutanese economy that is also picked up in our survey.

Education: Challenges and Possibilities

 Education and training are significantly linked to the job market and employment outcomes. If educational settings are not inclusive, persons with disabilities will not receive the requisite qualifications and skills necessary to compete for employment with their non-disabled peers. The statistics bear this out and are a grim picture of the failure to adequately prepare children with disabilities and other marginalized children for an adult life of socio-economic participation. For example, 17% of children worldwide are out of school completely, with most of the concentration of these children in low and middle-income countries and experience one or multiple disabilities. In fact, 90% of children with disabilities in LMICs do not attend school (UNESCO, 2020). 

The first step to support socio-economic participation of persons with disabilities is to ensure inclusion beginning from early childhood care and development (ECCD) and all the way through a student’s progression in the formal school system. Of course, inclusive education at the basic education level still faces significant challenges worldwide, although the paths forward are known (Schuelka, 2018b). Establishing inclusivity early in a student’s school progression will significantly improve a student’s chances to advance from basic education to upper-secondary education, from upper-secondary education to post-secondary education such as university or TVET (technical and vocational education and training), and from post-secondary education to employment (Ebuenyi et al., 2020). 

Participation of persons with disabilities in post-secondary education – e.g. university/college and TVET – is low worldwide. In the United States, the percentage of students with a disability in post-secondary education is estimated to be 19%, compared to 80% of non-disabled students attending post-secondary education (NCES, n.d.). The retention and graduation rate of persons with disabilities in the United States are about the same as persons categorized without a disability (Wessel et al., 2009). However, in low and middle-income countries the situation is worse. The percentage of students with disabilities in post-secondary education in LMICs is hard to measure. If 90% of children with disabilities do not attend school at all in low and middle-income countries, then it is safe to say that a very small percentage of persons with disabilities in low and middle-income countries attend any form of tertiary education. Of those persons with disabilities that do attend post-secondary education in low and middle-income countries, one study puts the completion rate at 4.5% (Thompson, 2020). 

There is still a significant correlation between educational attainment and socio-economic outcomes, although the strength of the relationship has lessened over time and is complex and nuanced as our survey highlights. In most countries, it is true that the higher the education level, the higher the income and lower the unemployment, and education is often framed as a significant return-on-investment that brings socio-economic lift to entire countries (Patrinos & Psacharopoulous, 2018; Wolla & Sullivan, 2017). However, these correlative relationships are reductive and require closer inspection. It is difficult to disentangle the means in which some students already have that allows them to continue in their schooling, while others must drop out. The correlation between educational attainment and socio-economic outcome must also be differentiated by sectors and also effect size on different socio-economic stratas. For example, in Kenya, higher educational attainment had less of an effect on informal, public, and agricultural sectors; and the effects of educational attainment were only significant at higher levels of education and only for formal private employment (Wambugu, 2011). In Bhutan, the correlation between educational attainment and employment has now actually reversed. In other words, the more schooling that one has attained, the less likely they are to be employed (Mannocchi & Schuelka, 2021). This is not just for youth with disabilities, but for all youth in Bhutan. The results from this survey confirm this trend as being true also for youth with disabilities in Bhutan. 

Even if the connection between formal education and socio-economic progress may be tenuous, the importance of post-secondary education to build employable skills and increase socio-economic participation is significant, as found in this survey. In a study in Bangladesh, it was shown that TVET had a significant impact for persons with disabilities in employment, social acceptance, and overall improvement in their quality of life (Nuri et al., 2012). Likewise with our survey, TVET was a significant predictor for gaining meaningful employment and the number of hours worked.  

Because of the impact that education – particularly TVET – can have on life outcomes for persons with disabilities, it is all the more important to address the challenges and barriers that impede participation. The challenges towards inclusive TVET and higher education are those that exist up and down the education system: inadequately prepared teachers that can utilize universal design for learning pedagogy, unadaptable rigid curriculum, lack of accessible materials and technologies and environments, prohibitive tuition, and other costs to attend, and exclusionary attitudes and policies, to name only a few. Formal education systems must also adapt and integrate into supporting socio-economic participation. This is particularly important for Bhutan, because schooling is still fairly didactic, exclusive, and cognitive-skill focused despite many reform attempts (Kezang Sherab & Schuelka, forthcoming). There is a clear separation between ‘school’ and ‘outside of school’ that needs to be broken down to make what is learned in school relevant to future adult outcomes of students. There have been some attempts to introduce more vocational training in secondary education in Bhutan, but this is optional and not standardized. More can be done to bring the community to the school, and vice-versa, for the sake of developing socio-economic and meaningful participation.

Conclusion

In summary, our survey results demonstrate that there is a desire to work for persons with disabilities in Bhutan, but there are few opportunities. According to our survey, only 29% of the participants with disabilities were working. Of those that are working, the majority work in a private business or a farm in their community. Most working persons with disabilities feel accepted by their coworkers.

Most participants with disabilities in our survey were not working. According to our survey, 71% of the participants with disabilities were not working. Of those that are not working, there was a strong desire to work, further employment skills and technical training, and find more employment opportunities in their community. For both working and non-working participants in our survey, the most common categories of desired employment included massage therapy, teaching, tailoring, painting, farming, hospitality; and private businesses like retail, grocery, and community services. These desired employment options mostly aligned with the work that was available to persons with disabilities, as indicated by the survey participants. According to our survey results, there was a significant correlation between employment opportunities and urban areas where there are more jobs available as well as more services and supports available to assist persons with disabilities in employment and social participation.

There are not enough meaningful activities for persons with disabilities to engage upon in their communities. According to our survey, 76% of the participants found ‘none’ to ‘very little’ activities available in their communities that matched their interests. Those activities that were identified for available participation primarily included religious practices, rituals, and festivals. This was not a surprising finding. In rural Bhutan, Buddhist lakhang [temples] are often the center of the community and many community activities, work, and interactions take place there. There are other common community activities that include sports such as archery and other field games. These were mentioned by the participants in our survey, but not strongly indicated as a preferred activity.

As indicated in our survey results and discussed above, there is a significant role that basic education and technical vocational education and training (TVET) can play in providing more life and work readiness skills that lead directly to employment and social participation. Most participants in our survey (81%) did not know of any places in their communities that they could go to learn about paid work opportunities. Most of our survey participants dropped out of school within 3 to 6 years because of health difficulties and examination failure. While one of our survey findings was that there was a positive correlation between TVET participation and employment, the number of years of schooling had a negative effect on employment outcomes. This means that schools are not providing the necessary kinds of life and work skills necessary and that more focus needs to be placed on school to post-school transition for students with disabilities. 

There were not significant findings in our survey in terms of disability stigma or persons with disabilities living independently. While disability stigma does exist to some extent in Bhutanese culture and society (Schuelka, 2015), there is a growing awareness of disability rights in Bhutan paired with new discourses on disability and Buddhism that promote compassion and social acceptance. Most Bhutanese live in multi-generational households regardless of ability, so living independently would not be a significant factor. However, a significant finding that we did discover in our survey was the influence of family support in employment and meaningful social participation outcomes. The support and high expectations of family was a contributing factor for positive outcomes for persons with disabilities in Bhutan.

This survey should not only have impact in Bhutan, but also resonate with other low and middle income countries facing similar challenges. Our survey results clearly point to the importance of school transition, TVET, family support, and high societal expectations as the primary factors for positive outcomes in employment and meaningful social participation for persons with disabilities. It is less important for rural, agrarian societies to push for independent living and salaried employment in private businesses for persons with disabilities, and more important to support opportunities for persons with disabilities to participate in their communities in a meaningful way. In Bhutan, as in other similar countries, it is important to recognize how each individual can contribute to the collective good of their communities to the best of their ability.

Acknowledgements

This research was funded by a Global Challenges Research Grant from UK Official Development Assistance, administered by the Economic and Social Research Council (ESRC ES/S004319/1).

We gratefully acknowledge our fieldwork team from Royal Thimphu College: Vanlallawmkimi (“Kimi”), Dip Raj Pradhan, Dago Palden, Jamyang Pelmo, Tshering Wangchuk, and Sonam Tshewang Ura. They collected data during the notorious monsoon season in Bhutan, and fell in flooded rice paddies and narrowly avoided dangerous landslides while still maintaining their sense of humor and dedication to improving the lives of persons with disabilities in Bhutan.

We were also supported by the following people and organizations in locating and contacting persons with disabilities in Bhutan and supporting the project in general: Dorji Norbu, Kinley Phytsho, Thinley Wangmo, Tamiki Nakishima (Bussi-En), Ability Bhutan Society, Sonam Yangden (Bhutan Foundation), Draktsho Vocational Training Centre, Tashi Choden, Gaden Chophel, Karma Lhamo, Phurpa Wangchuk, Chimi Lhamo, Beda Giri, Jayashree, Brian McDonough, Pooja Lepcha, Tshering Yangden, Bishnu Mishra, Phensem, and the Disabled Persons Organisation of Bhutan.

The full project investigation team are:  

Matthew J. Schuelka, University of Minnesota (Principal Investigator)

Brian Abery, University of Minnesota

Renáta Tichá, University of Minnesota

Christopher Johnstone, University of Minnesota

Luca Mannocchi, University of Birmingham

Sarah Benson, University of Birmingham

Paul Lynch, University of Glasgow

Sonam Ura, Royal Thimphu College

Kezang Sherab, Royal University of Bhutan

Partners and Funding Organizations

Global Challenges Research Fund logo.
Royal Thimphu College logo.
UKRI Economic and Social Research Council logo.
Foreign, Commonwealth, and Development Office logo.
University of Birmingham logo.

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Annex 1. Selected results of the comprehensive disability survey

A pie chart showing that 19% of survey participants have received financial support because of their disability and 81% have not received financial support because of their disability.
A pie chart showing the marital status of survey participants. 86% were single, 10% were married, 2% were in a long-term relationship, and 2% noted other.
A bar chart showing who survey participants live with. Participants could choose more than one answer. Approximately 90% lived with parents, 78% lived with siblings, 8% lived with grandparents, 15% lived with extended family, 30% lived with a friend, 10% lived with a partner, and 38% noted other.
A pie chart showing what kind of setting survey participants live in. 76% live in a house or apartment, 9% live in a school, 8% noted other, and 7% live in an institution.
A pie chart showing if people in your community think it is a good idea for people with disabilities to do paid work. 52% said some, 23% said none, 19% said most, 6% said all.
A pie chart showing, do people in your community avoid going to a business where a person with a disability is working. 57% said some, 19% said none, 18% said most, and 6% said all.
A pie charting showing would you feel comfortable asking for paid work in your community. 61% were not comfortable and 39% were comfortable.
A pie chart showing, are there places you can go or people you can speak to in your community where you can learn about available paid work? 81% said yes, 19% said no.
A word cloud showing what work is available. The most popular words were: business, farming, manual, government, private, hospitality, teacher, office, and factory.
A word cloud showing what work is available to you as a person with a disability. The most popular words were: farming, cleaning, painting, massage, tailoring, and household.
A bar chart showing how many years of secular/government schooling did you complete. 60% said 0 to 3.2 years, 10% said 3.2 to 6.4 years, 15% said 6.4 to 9.6 years, 18% said 9.6 to 12.8 years, and 5% said 12.8 to 16 years.
A bar chart showing the primary reason for leaving school before class 10. 42% said health difficulties, 21% said failed exams, 15% said poor quality education, 10% said long distance to school, 10% said lack of support, 12% said language difficulties.
A pie chart showing, have you ever participated in technical, vocational education training, or other such traditional arts or trades. 65% said no, 35% said yes.
A pie chart showing, would you like to further your work and life skills. 80% said yes, 20% said no.
A word cloud showing what jobs would you like to have. The most common words were: business, teacher, tailoring, painting, massage, therapist, farming, hotel, and driving.
A pie chart showing, have you had opportunities to learn job-related skills at school? 52% said not much, 22% said little, 17% said much, and 9% said a great deal.
A pie chart showing, does your family encourage you to participate in the community? 65% said yes and 35% said no.
A pie chart showing, are you currently working for money? (If not a student). 71% said yes and 29% said no.
A pie chart showing, do you feel accepted by co-workers (if working)? 89% said yes and 11% said no.
A pie chart showing where people are employed. 14% said at him (includes family farm), 10% said for someone else in the community (farm, lakhang), 10% said in a government office, 59% said in a private business, and 7% said self-employed.
A pie chart showing, are there activities available in your community that match your interests? 48% said ver little, 28% said non, 22% said several, and 2% said many.
A bar chart showing what activities do you take part of in your community? Nearly 120 survey participants said religious practices/rituals/festivals. Nearly 40 participants said studying, sports, and family. events. Nearly 30 participants said community events/groups. Nearly 20 participants said other. 5 participants said national service activities.

Authors

Matthew J. Schuelka University of Minnesota

Renáta Tichá University of Minnesota

Brian Abery University of Minnesota

Kezang Sherab Royal University of Bhutan

Ura Sonam Tshewang Royal Thimphu College