Phase 1 used Steps 1 and 2 of the eightfold path for policy analysis. Step 1 focused on defining the disability policy problems and Step 2 was for gathering evidence from the literature and the participants in Namibia. The first study was a desk-based analysis of the Namibian disability policy and a comparative analysis of disability policies of other Southern African nations using the UNCRPD as a yardstick. Findings from the first study revealed occupational injustice embedded in the discourse of the Namibian disability policy. Four forms of occupational injustice were identified in the study. Occupational marginalisation was present because of non-existence of evidence of active involvement of persons with disabilities in the formulation of the current disability policy in Namibia. Occupational deprivation persists as evidenced by the absence of state influence in ensuring accessible transport services for persons with disabilities. The latter are predominantly privately owned, and this results in the wide prevalence of inaccessible transport for persons with disabilities, even for those who can pay for transport. This significantly contributes to their isolation and occupational deprivation because they are denied opportunities to reach schools, workplaces and marketplaces for occupational participation. Occupational alienation is a form of injustice that refers to a sense of isolation and absence of meaning in occupational participation. Persons with hearing impairment, who for many years could only reach Grade 10 and have had to settle for menial tasks, are at risk of occupational alienation because of an absence of Grade 12 and tertiary education for learners with hearing impairments, which could lead to professional qualifications and better jobs. This can be traced to the disability policy not adequately addressing the educational needs of persons with hearing impairment.

Occupational inconsideration will be introduced more fully in the discussion to interpret some elements of the study findings. This concept will be proposed as a newly named form of occupational injustice. Occupational inconsideration refers to injustice whereby those in authority or in disability policy decision-making positions knowingly or unknowingly disregard the centrality of occupation in formulating disability policies.

Furthermore, the policy predominantly contains the passive voice. This limits implementation because when the passive voice is used there is no identification of who should take the responsibility to act. The frequent use of the word ‘shall’ in the disability policy makes it ambiguous. This implicitly propagates a background for the proliferation of occupational injustice faced by persons with disabilities in Namibia.

Namibia has not yet submitted the initial UNCRPD report, which was due in 2010 (UN 2018). This delay in submission of reports to some extent indicates lack of prioritisation to demonstrate domestication of the UNCRPD. Late submission is not unique to Namibia but includes other Southern African countries. Lack of expertise and resources have been cited as reasons for slow advancement on disability policies (UN 2018).

Phase 2 of the study continued Step 2 of the Bardach approach (2012), focusing on gathering evidence. The second study provided evidence gathered through interviews with 15 persons with disabilities, 8 disability policy decision-makers, as well as 2 focus groups with a combined total of 17 occupational therapists who had an interest in and understanding of occupational justice. Tables 1 and 2 describe the 15 persons with disabilities and decision-makers who participated in the study; Table 3 describes the 17 occupational therapists.

Barriers to occupational participation viewed as occupational injustice experienced by persons with disabilities in Namibia were divided into five categories: physical barriers; access barriers; expertise barriers; systemic barriers; and attitudinal barriers. There was a discrepancy of perceptions between disability policy decision-makers and persons with disabilities on occupational participation barriers experienced by persons with disabilities in Namibia, as well as their suggested policy changes. Persons with disabilities expressed more hindrances to occupational participation than those mentioned by disability policy decision-makers. There was far greater concurrence between perceptions of barriers among people with disabilities and occupational therapists. The discourse among persons with disabilities revealed a life of struggle and disadvantage. Table 4 shows the barriers to occupational participation mentioned by each participant group.

Evidence on perspectives of disability policy stakeholders and their lived experiences is a prerequisite when conducting policy analysis. In addition to barriers experienced by persons with disabilities in Namibia, the participants suggested policy reforms. Table 5 presents the policy decisions suggested by each participant group.

Only 4 out of 17 recommendations for policy improvements were consistently mentioned by the three participant groups, namely, accessible communication formats for all disability types; awareness raising on disability issues; access to education; and vocational skills training. Disability policy decision-makers had the least number of suggested policy improvements. The occupational therapists who participated in the study provided perspectives for creating an occupationally just environment that promotes occupational participation among persons with disabilities in Namibia.

As suggested by Bardach (2012), Step 3 is the construction of policy alternatives. The first alternative to be considered is to maintain the current state of things. The generated policy alternatives, which are based on research of suggested policy options from literature and the respective responses of persons with disabilities, occupational therapists and disability policy decision-makers in Namibia, fall into three main categories: access policy; support policy; and universal coverage policy.

If the current trends were to be maintained, the lives of persons with disabilities are not expected to improve. Firstly, the occupational injustice embedded in the disability policy and the policy environment in Namibia will remain; thus, the frustrations among persons with disabilities will continue to grow. Secondly, a laissez-faire approach is not likely to bring improvements to the lives of persons with disabilities because historically they have been oppressed and denied equal opportunities compared to the general population. The Government of Namibia has signed the UNCRPD, a reflection of commitment to improve the quality of life for persons with disabilities; thus, allowing the present conditions to prevail is equivalent to abandoning the commitment already made to the international treaty. Hence, this alternative was not pursued further in this study.

Evaluative criteria are mental standards for evaluating the probable outcomes of identified policy alternatives; this is the fourth step of the eightfold path to policy analysis (Bardach 2012). The evaluative criteria that were set for this study were based on evidence obtained from the following data sources: disability policy documents; persons with disabilities; occupational therapists; and disability policy decision-makers in Namibia. Furthermore, the experiences and understanding of the authors of the disability policy environment and local context, as well as the ethos of the study, influenced the evaluative criteria that were selected. The latter were: justice; inclusion; affordability; and political acceptability. Explicitly providing these criteria allows readers to have a clear understanding of the reasons behind suggested policy options and recommendations.

Justice was selected as the first criterion in this study because it is about fairness and thus linked to rights of persons with disabilities as equal citizens. Rights-based criteria are favourable in selecting ‘better’ policies (Bardach 2012). In addition, justice falls within the domain of critical theory whereby the targeted outcomes include emancipating people from situations that suppress their rights. Thirdly, justice, as a criterion, is compatible with the human rights disability model used in this study and the UNRCPD principles. Lastly, the concept of justice is embedded in the occupational justice framework – the conceptual framework for this study. Thus, outcomes of policy alternatives were judged on how fair and unbiased they were towards permitting or promoting persons with disability to participate in occupations of their need and choice.

The second criterion is inclusion, which means determining whether implementation of identified disability policy alternatives results in persons with disabilities being accommodated in all spheres of society with clear involvement and participation in decision-making about their lives. This criterion satisfies the motto: ‘Nothing about us without us’. Furthermore, it encompasses the consideration of contextual factors that predispose people to exclusion as outlined in the occupational justice framework such as gender, disability or ethnicity.

The third criterion, affordability, was used to judge the resultant disability policy outcomes when suggested policy alternatives were assessed on the first two criteria of justice and inclusion. This means that an alternative with an outcome that is just and inclusive was further assessed in terms of the cost of resources required. Affordability depends on the type of economy, which constitutes the underlying occupational determinants of the occupational justice framework. Income status or wealth is also among the contextual factors that can contribute to outcomes of either occupational justice or injustice. Policy alternatives that are unaffordable will not be executed even if they meet the first two criteria.

Political action is a prerequisite for the implementation of any disability policy alternatives. Therefore, political acceptability was the fourth criterion used to judge the projected outcomes of policy alternatives after satisfying the previously mentioned three criteria. Political acceptability focused on assessing the political will for the implementation of policy options with least resistance.

Table 6 presents a tabulated outcomes matrix grid to project the probable outcomes of each policy alternative when subjected to the set evaluative criteria. This is Step 5 of the Bardach approach. The matrix shows the suggested policy alternatives in the rows and evaluative criteria in the columns (Bardach 2012; Kanna 2006). The projected outcomes for each policy alternative (access, support and universal coverage) were measured against the extent to which they satisfied the four evaluative criteria (justice, inclusion, affordability and political acceptability). All the selected evaluative criteria were given equal weighting; this was informed by the literature on the basis that if any outcome of a policy alternative would not satisfy any of the evaluative criteria, that policy option would not be useful. Thus, the higher the score, the more it meets the evaluative criteria; the policy option would therefore be most likely to address the identified needs of persons with disabilities. Conversely, the lower the score, the less it addresses their needs. A common qualitative interval measurement scale was used for assessing evaluative criteria as shown below:

The higher the total score, the fewer trade-offs for the particular policy alternative, hence the more favourable it is. Table 6 shows that the policy alternative for access policy had the fewest trade-offs (10/12); the alternative of support policy had the most trade-offs (5/12). Following is an account of the probable outcomes of each policy alternative, and the trade-offs, based on how each alternative fared on evaluative criteria.

Considering the trade-offs of probable outcomes if policy alternatives were to be implemented is Step 6 of the Bardach approach. The following discussion presents the probable outcomes for each disability policy alternative and the trade-offs when judged based on each evaluative criterion.

Steps 7 and 8 of the Bardach approach entail deciding on and telling the story, respectively. Detailed application of these two steps is beyond the scope of this study. Firstly, this is because the study focused on generating evidence that can be used for disability policy formulation in Namibia by presenting different policy alternatives and their trade-offs without being prescriptive on a single disability policy alternative (deciding). Secondly, telling the story (Step 8) involves developing a communications plan, going back to the field to engage different stakeholders with the results and seeking their buy-in on a selected disability policy alternative.

Steps 1 and 2 (defining the problem and gathering evidence) were addressed in Phases 1 and 2. In Step 3, the following three disability policy alternatives were generated: access policy, support policy and universal coverage policy. Four evaluative criteria were set in Step 4: justice, inclusion, affordability and political acceptability. For Step 5 an outcomes matrix was presented to project the probable outcomes when each policy alternative is judged based on the set evaluative criteria. In Step 6 a discussion on the trade-offs for each disability policy alternative is provided concerning promotion of occupational justice using a critical disability theory lens. The access policy alternative had the fewest trade-offs – that is, the highest score – followed by the universal coverage policy alternative and lastly the support policy alternative.

The policy analysis has prompted naming a new form of occupational injustice as occupational inconsideration. Findings from the policy documents and participants in Phases 1 and 2 of the study reveal a disparity between perceptions of disability policymakers and persons with disabilities on the occupational needs of persons with disabilities. This disparity results in policymakers designing and approving disability policies that are inconsiderate of the need to ensure occupational participation among persons with disabilities.

The adopted dictionary definitions for inconsiderate include ‘without due regard for the rights or feelings of others’; ‘insensitive’; ‘ill-advised’. Occupational inconsideration thus exists when disability policymakers design policies or services targeting persons with disabilities without carefully considering how occupational participation for the intended target audience will be achieved. Further research of this concept, including involvement of a broader range of stakeholders in disability and rehabilitation services, is necessary.