Tuesday, October 20, 2020
Health And Welfare

How the South African government is failing people with disabilities

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The United Nations adopted 17 Sustainable Development Goals (SDGs) in 2015. Based on the principle of “leaving no one behind”, the SDGs emphasise a holistic approach to achieving sustainable development for all.

Disability is referred to in numerous SDGs, specifically in relation to education, growth and employment; inequality; and accessibility of human settlements. They are an important step towards addressing the barriers faced by persons with disabilities.

The World Bank estimates that 1-billion people – 15% of the world’s population – experience some form of disability, with a higher incidence in developing countries. South Africa is no exception. The 2011 census reveals the national disability prevalence rate is 7.5%. Disability is more prevalent among females compared with males (8.3% and 6.5%, respectively). The number of people with disabilities increases with age, with more than half (53.2%) of people aged 85+ having reported a disability.

It is hardly surprising, although still distressing, that the World Bank notes that people with disabilities, on average as a group, are more likely to experience adverse socioeconomic outcomes than people without disabilities, such as difficulty in accessing education, poorer health outcomes, lower levels of employment, and higher poverty rates.

Indeed, the South African Human Rights Commission states that people with disabilities “continue to lack access to adequate health and basic education, and are at risk of economic isolation with no prospect of securing employment”.

People with disabilities ‘continue to lack access to adequate health and basic education, and risk economic isolation with no prospect of securing employment’

A country’s legislation may help or hinder people with disabilities to overcome barriers to economic, civic and community life. Widely regarded as one of the most progressive constitutions in the world, section 9 of the South African Bill of Rights specifically states no one may be discriminated against on the grounds of disability, among others. This section also expressly protects the rights of disabled persons by providing that the state must take whatever steps necessary “to protect and advance persons, or categories of persons, disadvantaged by unfair discrimination”. These steps are inclusive of the enactment of national legislation, as well as the monitoring of the development of such vulnerable groups.

One example of national legislation that could go a long way in relieving some of the monetary burdens experienced by persons with disabilities is the South African Income Tax Act. This is because disabled taxpayers (or those who support a disabled dependant) face large, non-discretionary expenditures and undergo economic hardships that others do not. In an attempt to recognise this, the Income Tax Act was amended in 2008 to enable taxpayers to claim certain eligible disability-related expenses (medical or otherwise).

The South African Revenue Service (SARS) subsequently issued a list of medical expenses that could qualify for a tax deduction, as well as establishing criteria for the diagnosis of a disability. Despite this, the application of the disability tax provisions remains problematic, as the interpretation thereof is subjective and difficult to apply. Not only that, but due to the design of SARS’s operational system, many taxpayers have to wait for ages to receive their tax refunds.

A few years ago, we changed from a medical deduction to a medical rebate (or tax credit) system. This new system was aimed at a more equitable treatment of taxpayers, but has not had quite the desired effect. Taxpayers who have to incur disability-related expenses are at a disadvantage. Taking into account the time value of money and opportunity cost, having to wait for months (or years) for a refund of one’s own hard-earned taxes is simply unfair. An amendment to the tax law to expedite refunds in connection with a medical rebate would certainly help. In addition, the introduction of a separate medical rebate – akin to the Canadian disability tax credit – would provide for greater tax equity.

The government, through the South African Social Security Agency, provides a variety of taxpayer-funded social security grants, including a disability and care dependency grant. Laudable though this is, the grant of R1,600 per month is woefully inadequate to cover often exorbitant disability-related expenses, which could easily increase by more than the annual inflation rate. Moreover, “Sassagate” has not yet concluded and it remains to be seen how the floundering Department of Social Development will be ready to take over the payment of social grants to 17-million vulnerable South Africans.

In 2016, at least 118 of Gauteng’s most vulnerable mental illness patients (including persons with “severe intellectual disability”) died after the provincial health department had terminated its contract with Life Esidimeni and moved the patients to defective NGOs. The arbitration hearings are underway, with shocking testimonies coming to light. The legal consequences of this catastrophe are manifold. Numerous basic human rights, including the paramount right to life, were flouted. In his report, the health ombudsman said the provincial health department ignored warnings and moved patients out of Life Esidimeni into “ill-equipped” and “unlicensed” NGOs. In fact, he likened the move to that of an “auction cattle market”, where patients were left to die in poor conditions. The supreme tragedy of the Life Esidimeni saga is that it was entirely avoidable.

The 2030 Agenda for Sustainable Development clearly states disability cannot be a reason or criteria for lack of access to development programming and the realisation of human rights. It is imperative that we exercise whatever influence we have in our circles – whether that be as business leaders, tax practitioners, lawyers, NGOs, government officials and civil society – to help ensure that truly no one is left behind.

Lee-Ann Steenkamp is a senior lecturer in taxation and head of the Postgraduate Diploma in Financial Planning at the University of Stellenbosch Business School. She is also a registered Master Tax Practitioner. 

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