People with Disabilities in India: From Commitment to Outcomes

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Addressing Prevention and Treatment of Disability 50. Improvements in access to care and outcomes for PWD are needed in several areas, some of which are in the general public health and health delivery systems and other specific to services for disabled people: 51. Improving identification and certification of disability: A thorough review of the existing early identification system for disability - with strong coordination between the ICDS system, local health care providers (both public and private) and communities - is needed to improve early identification of disability. This effort needs to be accompanied by improved outreach and possibly simpler procedures for disability certification, including raising awareness that such a system exists and exploring new approaches to disability certification that exploit private sector medical capacity in the face of serious public sector supply constraints on certifying doctors. 52. Minimizing the incidence and severity of disability: Cost effective interventions to minimize disability need to be strengthened, including iodization of salt (recently made mandatory once more), and micronutrient supplementation for children and pregnant women. This would include a reversal of declining immunization coverage (polio excepted), which contributes to both disability and mortality rates. Current efforts such as provision of simple aids such as glasses or crutches also need to be expanded – in partnership with the private sector – to prevent mild impairments becoming serious disabilities which compromise learning, work, and other activities of daily life. The importance of simple interventions such as cataract surgery and hearing devices will also increase with an ageing population. However, other efforts will be needed beyond the health sector. Efforts to promote road safety are an important case, with the rapid expansion in accident-related disability (estimated by the Planning Commission to cost India around Rs. 55,000 crore annually at 2000 prices). While the draft National Road Safety Policy is one step, greater efforts at the state level such as those being pioneered in Kerala are needed to stem the major increase in traffic injuries and death. The draft National Road Safety and Traffic Management Bill soon expected to be introduced is another important effort to address the institutional and other challenges to improving road safety, 53. Improving quality of care for disabled people: Key actions to be taken include: (i) better integrating disability management in existing health delivery systems. Departments of social welfare, health and W&CD have to work together and in tandem with early intervention through the education system, NGOs and communities. This would include joint disability training for local level service providers and communities based on common mandates, combined with incentives and identification of influential champions. Improving training of PWD as health advocates and field facilitators is needed if they are to become active agents and not passive beneficiaries; (ii) improved referral systems for the existing rehabilitation network, followed by increased funding and personnel (whose levels are currently at less than 10 percent of WHO standards for developing country rehabilitation services); (iii) a stronger distribution network for Government programs of aids and appliances, including awareness raising of among PWD; (iv) improved centers and resources devoted to disability management, including assessment, rehabilitative services and medical intervention Indian organizations have capacity to develop low cost technology for PWD, but need adequate funding and incentives, and finally, (iv) more aggressive efforts to develop government and NGO partnerships in all areas of disability services will be needed to strengthen service delivery (in particular with respect to community-based rehabilitation); and finally (v) continued efforts to ensure that prevention of disabilities through immunization and other preventive measures is strengthened. xxiv
54. Addressing current and future provision and information gaps. New legislation and its enforcement are needed, particularly in the areas of mental health and road safety (including emergency and trauma care), both of which are assuming increasing importance as causes of disability. The aging of the population and attendant disability needs of the elderly will need to be addressed in the future. Finally, data and statistics on disability need to be more reliably and regularly collected, in particular through strengthened NFHS and general health surveys, which have neglected disability. 55. Given capacity constraints, improving the health sector’s response to disability may most feasibly happen in two phases. The first phase could concentrate on accelerated response closest to the community level. This would include an improved certification system, promotion of CBR (including awareness raising and stigma reduction elements), and enhancing micronutrient supplementation (including options for food fortification) and immunization. The supply side interventions would need to include training of general duty medical officers in disability certification, and of community volunteers. The second phase could focus on improved referral systems between levels of the health system, including increased supply of therapists and support for establishment of therapy centers in rural areas. It would also likely involve networking of hospitals and specialized centres, possibly with support form the private corporate sector. Improving the quality and access to education 56. More than most sectors with regard to people with disabilities, the education sector has been relatively progressive in policy terms, and has also committed to a progressive menu of options for delivering education to children with special needs. However, there are a range of challenges in turning policy into effective practice for a variety of reasons, and India will not achieve its MDG goals without substantial improvements in outcomes for disabled children. Some of the elements in executing this agenda include: 57. Improving access to education: Identifying childrens’ impairments and learning capacities early and getting them into some form of education is a critical first step, which remains an incomplete agenda to date. It will be important to review the SSA systems for identifying children with disabilities entering the education system, and explore their convergence with early identification systems prior to school age. In most states, these systems are struggling to identify many children with disabilities, and by operating parallel systems, may be overburdening anganwadi workers and others with reporting demands. Improved initial identification needs to be complemented with development of simple systems for ongoing schoolbased assessment of emerging (and often easily reversible) disabilities. All new school construction should also be physically accessible and current efforts of retrofitting accelerated. 58. Improving the quality of education services: GOI should require all states to develop a strategy for delivering education to children with special needs, in order that SSA and other central funds can be allocated in a less mechanical manner. This strategy would assist in improving the currently poor expenditure performance, and more importantly move the system towards a genuinely child-centered allocation which can provide parents and local authorities with more options and greater accountability for resource use. Secondly, a key element of strategy execution must be making the special needs resource centre model operational. In many states, this will require piloting of different models with good evaluation. Thirdly, current efforts to make the curriculum accessible and adapted to the learning needs of children with disabilities need to be accelerated. This is recognized in the National Curriculum Framework of 2005. For special education curricula, greater efforts to assess the needs of children in activities of daily xxv
Page 1 and 2: PEOPLE WITH DISABILITIES IN INDIA:
Page 3 and 4: Abbreviations and Acronyms ADL ANM
Page 5 and 6: Table of Contents EXECUTIVE SUMMARY
Page 7 and 8: Figure 5.3: Employment rates of PWD
Page 9 and 10: Box 5.4: A Jobs Fair Bringing Emplo
Page 11 and 12: NGOs, both quantitative and qualita
Page 13 and 14: Out of school rates for CWD are hig
Page 15 and 16: needs to respond more proactively t
Page 17 and 18: government strategies for promoting
Page 19 and 20: Safety Net Schemes 33. Safety nets
Page 21 and 22: 40. In early 2006, a National Polic
Page 23: should move to implement the Act’
Page 27 and 28: disability SHGs, which has been sho
Page 29 and 30: have comparative advantage is putti
Page 31 and 32: extent of individual functioning du
Page 33 and 34: converting income into well-being o
Page 35 and 36: 21. In light of the challenges that
Page 37 and 38: not be explained by this. The major
Page 39 and 40: Table 1.2: Disability Prevalence ra
Page 41 and 42: The share of disability impact due
Page 43 and 44: • It is also important to recall
Page 45 and 46: 1.17. A second issue with obvious i
Page 47 and 48: Figure 1.9: Employment rates of PWD
Page 49 and 50: Box 1.2: Census questions on disabi
Page 51 and 52: Box 2.1: Disability in Indian mytho
Page 53 and 54: • overall, there is low acceptanc
Page 55 and 56: Table 2.2: Positive perceptions of
Page 57 and 58: different areas, as for example the
Page 59 and 60: governmental sectors drive home the
Page 61 and 62: Box 2.4: Raising awareness and chan
Page 63 and 64: • onset of mental disabilities is
Page 65 and 66: 3.9. Locomotor disability is the ca
Page 67 and 68: B. Prevention of Disability 3.15. A
Page 69 and 70: 3.20. The NBCP, like other vertical
Page 71 and 72: almost three times more likely to h
Page 73 and 74: PWDs. The scheme operates in 11 cen
Page 75 and 76:
Figure 3.4: Proportion of disabled
Page 77 and 78:
Table 3.11: Type of Service Accesse
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Urban 1.46 North 1.40 South 1.10 Ea
Page 81 and 82:
Box 3.1: WHO’s “Ten Question Pl
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3.51. (f) Financial barriers to acc
Page 85 and 86:
including for road accidents, and e
Page 87 and 88:
A. Indian and International Policy
Page 89 and 90:
4.9. A specific feature of SSA is a
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• significant gender differential
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Out of school rates for CWD are hig
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Only around 5 percent of children w
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4.30. (b) Financial performance of
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only factor contributing to both po
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The numbers of CWD identified by SS
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IE training options. The impacts of
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part of the authorities to increase
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well beyond the needs of CWD alone.
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performance in the schooling system
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DLROs has contributed to West Benga
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CHAPTER 5: EMPLOYMENT OF PERSONS WI
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atios, while others such as J&K, Bi
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Figure 5.8: Employment rates over t
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• the relative wages of PWD to no
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of age and disability status. Multi
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5.23. For males in the survey, a de
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equirement of specific post identif
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5.34. Nonetheless, there has been u
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consistent with survey findings. Na
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exchanges are in any event servicin
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Source: NHFDC website reporting cum
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Box 5.5: Good practice in NGO skill
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D. Conclusions and recommendations
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is set. In the case of SGSY, the gu
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Table 6.2: States/UTs with unemploy
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Table 6.4: Coverage of disability s
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Table 6.6: Contributions and benefi
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6.24. Easily the largest scheme for
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6.35. While the design of the insur
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people. The transfer under NOAPS wa
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7.4 (a) The Persons with Disabiliti
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7.8 (ii) Sectoral policy issues in
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• in the area of education, the p
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awareness raising about disability
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more formal institutions in disabil
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7.28 There is little detailed analy
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Table 7.2: Institutions providing b
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systematically related to the numbe
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• collaboration between NGOs and
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moving to improved outcomes for PWD
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CHAPTER 8: ACCESS FOR PEOPLE WITH D
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Box 8.1: International and regional
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The comparison of institutional arr
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laudable, there are concerns that m
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ANNEX 1: COMPARING THE INCOMPARABLE
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of prevalence estimates across the
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person will be treated as having
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People with Disabilities in India: From Commitment to Outcomes

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