People with Disabilities in India: From Commitment to Outcomes

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disability need to be made (e.g. for access to benefits or services) which have simple decisionmaking rules consistent with limited institutional capacity, and thus avoid high levels of observation and/or discretion. 9. (c) Public Policy and Disability: Disability has public policy implications in several main areas: • prevention of disability • risk management and amelioration by either monetary or in-kind means (when disability can not be prevented) • the interaction of poverty and disability in a context of widespread poverty and vulnerability • the interaction of disability with delivery of public services such as education or health in a context where the general systems of service delivery face many challenges. • the role of public policy in areas like employment and attitudes where the market or social institutions play a dominant role. 10. Much of this report focuses on the question “Should – and if so, how should – public policy intervene in the area of disability ?”. The question must be addressed in the context of constrained public resources, which presents hard questions for India in terms of focusing marginal resources on the most effective channels for promoting opportunities for people with disabilities. It must also be asked with some sense of how current market and community-based or household arrangements succeed or fail in creating opportunities for PWD to participate fully in society. 11. Standard analyses would look to justify public intervention in the area of disability on the basis of market failures – either those that interfere with efficiency of the economy or those that are inspired by a desire for equity or social justice. That is, it may be that some problems associated with disability cannot be solved by people acting individually via ordinary market transactions. A somewhat more sophisticated analysis would balance the identification of such problems with explicit consideration of constraints on governments’ ability to address them. For example, some things, such as comprehensive disability insurance, are not available on the market for systemic reasons. However, they may be just as difficult to provide publicly for the same reasons. The following paragraphs discuss characteristics peculiar to disability that influence the ability of both private transactions and public policy to ameliorate the problems faced by PWD. They contrast both market and public action with social action – the informal support systems that people rely on – and ask when is there something public policy can do to strengthen market and/or social action outcomes for PWD, or when it might inadvertently weaken these systems. 12. (i) Analyzing the well-being of people with disabilities: Amartya Sen has persuasively pointed to the shortcomings of the dominant western theories of justice in analyzing the well-being of PWD relative to others in society. 10 An important distinction that he makes is between the “earnings handicap” which PWD typically face and the “conversion handicap”. While noting that PWD are typically poorer than average throughout the world (the earnings handicap), he also notes that they are doubly deprived in that they have greater difficulty in 10 Sen (2004) outlines the failures of utilitarianism, the Rawlsian theory of justice and the income/wealthapproach underlying welfare economics to accommodate disability, concluding that “none of the dominant theories of ethics and justice can really pay serious attention to the issue of fairness to the disabled”. -3-
converting income into well-being or good living (the conversion handicap). For example, a PWD may need to spend money to achieve the mobility that non-PWD achieve without cost (e.g. due to need for prosthesis or additional expenditures on transport). The conversion handicap which PWD face thus makes a given level of income yield a lower level of well-being relative to the non-disabled population. Calculations of the relative importance of the earnings and conversion handicaps from the UK indicate that around three quarters of the differences in poverty rates between PWD households and non-PWD households can be accounted for by the 11 conversion handicap and only around one quarter from the earnings handicap. 13. The above insight is important to keep in mind in assessing the empirical evidence in this report on the relative position of PWD. Several elements of the socio-economic profile are only able to capture the earnings handicap or equivalent in terms of access to services or other indicators. It is important to keep in mind that the conversion handicap makes the direct deficits that PWD typically face (e.g. in income of access to services) very much lower bound estimates of the total welfare loss that disability imposes on them. 14. (ii) Disability and risk management: A core challenge that disability poses for public policy is mitigation of risk, both the risk of being born with an impairment and the risk of acquiring one later in life. It is problematic since both private markets and public provision are subject to severe constraints. Ideally, insurance would make it possible for someone to buy a policy that would “make good” any losses – monetary or psychic – caused by a chance event that results in impairment. Not only would one be able to buy health insurance in the case of an injury (to pay for medical care costs), but also disability insurance to replace the loss of earnings the injury might lead to. Similarly, it would be ideal if parents could buy an insurance policy that would pay compensation for any congenital impairments in their new-born. For various reasons, both markets and governments are unable to provide such comprehensive coverage. 15. Mitigating the risk of disability is subject to two major challenges. The first is observability. Correctly observing the existence of a disabling impairment presents many challenges for both public and private systems. The situation is complicated by the fact that many impairments occur on a continuous spectrum (e.g. percentage loss in eyesight or reduction in IQ). This raises the question of at what point an impairment can be considered a disability, justifying public intervention or private insurance payout. For some kinds of impairments, there may be a clear threshold effect, but for many there may not. If there is a slow decline in earning capacity (or ability to enjoy life as in depression) as an impairment worsens, it takes considerable knowledge, time or resources to be able to tell at what point a person should become eligible for a public program or insurance payout. It is this need for substantial discretion on the part of an official or insurance agent that makes verification of disability prone to misuse either by the client or by the officer who can demand payment for a favorable decision. 16. The second challenge in disability is that of valuation. Once it is successfully observed that a person has a given level of impairment, there are major challenges in defining what would “make good” the well-being of the person. Even if in principle one could define the appropriate average compensation for a given type and level of impairment, it would be almost impossible to prove how much - in the individual’s specific context - the impairment has reduced well-being. Some elements of the estimation are possible (e.g. direct costs of medical treatment already undertaken or income lost). Others are possible to define but it is much more difficult to cost them (e.g. future lifetime medical costs or loss of earnings). Still others are not possible in 11 Kuklys, cited in Sen, op.cit. -4-
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 and 30: have comparative advantage is putti
Page 31: extent of individual functioning du
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
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Out of school rates for CWD are hig
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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
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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
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• the relative wages of PWD to no
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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
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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
Page 173 and 174:
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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