People with Disabilities in India: From Commitment to Outcomes

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INTRODUCTION AND FRAMEWORK 1. This section addresses two overarching themes which recur in the report. A brief discussion of each is useful by way of framing the main body of the report. The themes are (i) models of disability; and (ii) a framework for thinking about public policy and disability. 2. (a) Models of Disability: 7 Virtually all the literature on disability outlines the shift in disability policy thinking from the charity and medical models of disability towards social model of disability. The various models can be described briefly as follows: • the medical model of disability relies on a purely medical definition of disability. It thus equates the physical or mental impairment from a disease or disorder with the disability that the person experiences. From a policy viewpoint, the person with disability is viewed as the “problem”, and in need of cure and treatment. In terms of services, the general approach within this model is towards special institutions for people with disabilities, e.g. special schools, sheltered workshops, special transport etc. The limitations of the pure medical model are evident, though it till underlies some current analysis such as that based on disability-adjusted life years (DALYs). • the charity model of disability also view the person with disabilities as the problem and dependent on the sympathy of others to provide assistance in a charity or welfare mode. • the social model of disability “places the emphasis on promoting social change that empowers and incorporates the experiences of PWD, asking society itself to adapt”. 8 The social model emphasizes institutional, environmental and attitudinal discriminations as the real basis for disability. Thus it is the society at large which disables the person with disabilities through discrimination, denial of rights, and creation of economic dependency. • the rights-based model of disability builds on the insights of the social model to promote creation of communities which accept diversities and differences, and have a nondiscriminating environment in terms of inclusion in all aspects of the life of society. 3. It took time to build consensus on a conceptual framework which reflected dimensions of disability beyond the medical. The International Classification of Impairments, Disability and Handicaps (ICIDH) from WHO in 1980 was a breakthrough in this evolution. It recognized that personal, social and environmental factors are all at play in “creating” disability. This acknowledged that not only physical or mental impairments but the attitudes and institutions of society had significant impacts on the opportunities of PWD. 4. The ICIDH-2 from 1997 represents a further step in this process. It defines disability as: “..an umbrella term covering three dimensions: (i) body structures and function; (ii) personal activities; and (iii) participation in society. These dimensions of health-related experience are termed “impairments of function and impairments of structure”, “activities” [i.e. nature and 7 This section draws from Metts (2000), and inputs from Alana Officer. 8 See DFID (1997).
extent of individual functioning due to impairments], and “participation” [the nature and extent of a person’s involvement with life situations] respectively”. 5. While the language of ICIDH-2 is dense, the intuition is simple. Limitations on PWD participation in the life of their society are created by the interaction of general environmental factors (e.g. the built environment; societal attitudes), individual-specific factors (e.g. gender, age or education), and the impairment(s) that the individual has. The ICIDH-2 is sometimes termed a biopsychosocial model of disability. The model is presented in diagrammatic form in Figure 4. Figure 4: The ICIDH-2 Framework for Understanding Disability Health Condition (disorder/disease) Impairment Activity Participation Contextual Factors A. Environmental B. Personal C. Institutional Source: WHO. 6. Metts provides a useful explication of the ICIDH-2 approach, noting that “people may…: • have impairments without having activity limitations (e.g. disfigurement but no activity limitation) • have activity limitations without evident impairments (e.g. experience poor performance in activities due to disease) • have limited participation without impairments or activity limitations (e.g. discrimination due to past mental illness or HIV) • experience a degree of influence in the reverse direction (e.g. experience muscular atrophy due to inactivity or loss of social skills due to institutionalization).” 7. The ICIDH-2 was followed by the International Classification of Functioning (ICF), which skips the linkage between health conditions and functioning, and classifies functioning directly, using the same domains as ICIDH-2: body functions, activities and participation). The ICF has developed more detailed classifications of functioning with respect to products and technology, natural and man-made environments, support and relationships, attitudes, and services, systems and policies. 9 8. In broad terms, this report adopts the ICIDH-2 approach to disability, though the practical differences to the ICF approach are not significant. The combination of medically-based and socially determined definitions of disability that it offers seems particularly appropriate to a poor developing country. It is also useful in terms of public policy, where determinations of 9 See WHO website. -2-
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 and 24: should move to implement the Act’
Page 25 and 26: 54. Addressing current and future p
Page 27 and 28: disability SHGs, which has been sho
Page 29: have comparative advantage is putti
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
Page 79 and 80: Urban 1.46 North 1.40 South 1.10 Ea
Page 81 and 82:
Box 3.1: WHO’s “Ten Question Pl
Page 83 and 84:
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
Page 91 and 92:
• significant gender differential
Page 93 and 94:
Out of school rates for CWD are hig
Page 95 and 96:
Only around 5 percent of children w
Page 97 and 98:
4.30. (b) Financial performance of
Page 99 and 100:
only factor contributing to both po
Page 101 and 102:
The numbers of CWD identified by SS
Page 103 and 104:
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.
Page 109 and 110:
performance in the schooling system
Page 111 and 112:
DLROs has contributed to West Benga
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CHAPTER 5: EMPLOYMENT OF PERSONS WI
Page 115 and 116:
atios, while others such as J&K, Bi
Page 117 and 118:
Figure 5.8: Employment rates over t
Page 119 and 120:
• the relative wages of PWD to no
Page 121 and 122:
of age and disability status. Multi
Page 123 and 124:
5.23. For males in the survey, a de
Page 125 and 126:
equirement of specific post identif
Page 127 and 128:
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
Page 159 and 160:
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
Page 181 and 182:
ANNEX 1: COMPARING THE INCOMPARABLE
Page 183 and 184:
of prevalence estimates across the
Page 185 and 186:
person will be treated as having
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People with Disabilities in India: From Commitment to Outcomes

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