People with Disabilities in India: From Commitment to Outcomes

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higher estimates are also more consistent with comparable international estimates of disability from WHO and individual countries. • it is clear from primary field research from this report (and previous work) that significant categories of people who are functionally disabled will not typically be identified by households as being disabled. The primary example of this is elderly people with significant functional impairments who were not disabled before they became old. In field work, the standard answer on probing was that even seriously functionally impaired elderly people were “just old” or “like many other old people” rather than disabled. The main exception was elderly disabled people who were disabled before becoming old. Given the relatively higher rates of functional disability among elderly populations worldwide, such cultural factors are likely to be a significant source of under-estimation of disability prevalence. • the social stigma attached to disability is also likely to contribute to under-estimation. 16 Chapter 2 provides insights on the strong stigma often attached to disability in India. Stigma – as in many countries – seems to be particularly pronounced for mental illness and mental retardation. Stigma is a factor in many countries, but Indian notions of karma seem likely to make the problem of lack of identification by households more pronounced in India. 1.6. Due the above and other factors, official disability estimates in India can therefore be considered a more reliable estimate of serious disabilities, particularly for mental retardation and mental illness. A more inclusive definition would appear to include around80- 90 million people. It is stressed that the total figure of over 90 million (or around 8 percent of the population) is not intended to be “the” estimate of disability prevalence, but simply to indicate that reasonable alternative definitions and reliable sources find a possible prevalence rate of disability which is considerably higher than the official NSS and census estimates. It also points to be great importance of mental illness in overall prevalence, an area of particular difficulty in measurement. This points to the complex issues of both definitions for measurement and of conducting interviews with non-specialist interviewers. 1.7. International evidence from developing and developed countries provides useful insights for interpreting both official disability estimates for India and those from reliable alternative sources. Several pertinent findings on international experience in estimating disability prevalence are: • how disability questions are asked matters, and India’s methods of asking in both NSS and census tend to generate the lowest disability estimates worldwide. This can be seen in Table 1.2, where prevalence rates are seen to vary sharply according to how the disability questions are asked. Interestingly, many countries find a prevalence range of 1-3 percent using India’s current method of asking disability questions, while activity-based questioning yields higher rates. More detail on the different approaches is provided in Box 1.1. 16 See Harriss-White (1995). -9-
Table 1.2: Disability Prevalence rates by country and disability question method, various years Country and question type Disability prevalence rate (% of population) Do you have a disability ? Yes/No Nigeria 0.5 Jordan 1.2 Philippines 1.3 Turkey 1.4 Mauritania 1.5 Ethiopia 3.8 Jamaica 6.3 List of Conditions Colombia 1.8 Mexico 1.8 Palestine 1.8 Chile 2.2 Uganda 3.5 Hungary 5.7 Activity-based questions Poland 10.0 United Kingdom 12.2 Brazil 14.5 Canada 18.5 United States 19.4 Source: Mont (2007) • it is not unusual for different official surveys from the same country to yield different estimates of disability, even where interviewer capacity is high. An extreme case is provided by Canada, which has estimates from various official sources ranging from 13.7 to 31.3 percent. In the region, there are also significant variations across source in disability estimates, e.g. in Sri Lanka, the census-based estimate is 1.6 percent, while a UNICEF survey estimated around 4 percent prevalence. • official disability prevalence rates tend to rise with country income levels. This is a product of various factors, but would appear to be less about the “true” rates of disability (though older age structures are a factor in that respect) as other factors. These include more inclusive definitions of disability, better measurement and identification, social security systems which provide incentives to self-declare as disabled etc. 17 • despite the general pattern of rising disability rates with higher country income, developing countries which have implemented more advanced survey and census-based measurement have found notably higher prevalence rates of 10-15 percent of the population. Three notable examples are Brazil, Zambia and Nicaragua, which also demonstrate that new forms of measurement can be achieved even in very low income and capacity settings. Brazil for example moved from around a 1 percent prevalence rate to 14.5 percent with a change in the method of asking questions in its census. Using other household surveys with improved methodology, Nicaragua’s rate is just over 10 percent, while Zambia has a rate of around 13 percent. The example of the change in questions for Brazil is given in Annex 2. 17 There may also be strong political incentives to increase disability rolls, e.g. prior to elections, when political incentives drive recategorizing of “unemployed” people to “disabled”. Another example is during periods of economic restructuring (as for example, in transition countries during the 1990s) when putting laid-off older workers onto disability benefits may provide more sustained post-layoff social protection and dilute public perceptions of the unemployment impacts of enterprise restructuring. -10-
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 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: not be explained by this. The major
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
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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.
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
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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
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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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