Contested notions of disablement and 'deservingness' in disability grant assessments in South Africa
This paper examines the interactions between doctors and claimants during assessments of medical eligibility for disability grants (DGs) in South Africa. Based on ethnographic work in clinics and hospitals, I show that disability assessments are sites of negotiation and contestation between doctors, claimants and the state over how social security rights should be allocated. Focusing on five cases of ‘resistance’, I show how disability as a social, medical and administrative category was socially and discursively constructed, (re-)defined and applied in ways that contradicted official policy. I argue that doctors’ divergence from rules and guidelines was driven by differences between the government’s bureaucratic framing of disability and the alternative frames doctors used for making sense of cases and thinking about disability, illness and employability in the South African context. Doctors’ framing of disability grant cases was shaped by their social and cultural backgrounds and dispositions, professional knowledge and values, as well as broader discursive framings of rights and social justice. Claimants also asserted their own subjective understandings of disability during assessments, using their agency to resist the objectifying process of disability categorisation and attempting to have their experiences of physical, social and financial suffering 'seen' and legitimised by the state. They used performances of disability, narratives of suffering, social pressure and threats of violence to manipulate or coerce doctors into recommending grants or to voice their frustration with perceived unjust treatment. This paper makes an original empirical contribution to the study of conceptions of disability as a category of the ‘deserving’ poor in a context of high poverty. It also highlights the influence of norms and values in the allocation of welfare rights at the street-level and demonstrates how the agency of both frontline workers and citizens can shape policy implementation. This provides useful insight into the ‘gap’ between policy and practice.