People with Disabilities in India: From Commitment to Outcomes

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CHAPTER 3: HEALTH AND PEOPLE WITH DISABILITIES 3.1. Disability is both a “lens” through which broader health policy issues can be viewed, as well as a specific set of needs of people with disabilities that health policy and systems need to address: Both prevention and management of disability are core issues in general in access to health. It is difficult to separate the interventions that are disability-specific from those that are related to health of the population in general. In this sense, disability is a lens through which health policy issues can be viewed. However, when it comes to diagnostic, screening and rehabilitative services for PWD, a disability-specific dimension enters health policy, particularly when institutional structures need to be reformed to improve access and outcomes for PWD. 3.2. In much of the world, the literature on health and disability is typically framed within a medical model: India is no exception. Thus, much of the literature on disability and health in India sees disability within a disease framework. Hence, PWD are viewed as “patients” in need of “treatment”. Empirical evidence also comes predominantly from the medical discipline, focusing on causes of disability and clinical trials; although some recent studies have focused on poverty correlates and social stigma issues that affect PWD. There is little information on access to health for PWD or their general and disability-specific health needs - except whether “treatment” was sought for the disability. Moreover, data do not allow an analysis of supply and quality of services available to PWD, and the extent to which this affects demand. 3.3. This chapter explores health issues for PWD. 48 The structure is as follows: Section A focuses on the causes of disability in India and implications of these for public policy. It includes a brief discussion of the institutional issues with respect to heath services for both prevention and treatment of disability. This is followed by a section on the preventive aspects of disability policy, and public programs which have aimed to reduced the incidence of disability in India. This is followed by a review of evidence on health seeking behaviour of PWD. A section on the health care system and both public and non-governmental interventions for treatment of PWD follows, before conclusions and recommendations. A. Causes of Disability in India 3.4. Chapter 1 reviewed evidence on the incidence of disability in India by disability type. It was seen that there remains considerable uncertainty on the relative shares of different disability types in the overall composition of the disabled population. This section focuses in more detail on the causes of different types of disability, using primarily NSS sources. While NSS data are subject to the caveats noted in Chapter 1, this remains a useful source of insight. 3.5. (a) Age of onset of disability: Chapter 1 provided cross-disability data on average age of onset of disabilities, noting the “double hump” of disability onset, first at our shortly after birth and then in the 50-60 year old cohort. However, cross-disability averages conceal as much as they reveal. The figures below provide disability-specific data on age at onset by major disability categories. The age profile of disability onset varies sharply by category of disability. Some notable patterns stand out: 48 The chapter draws on background papers by Das (2006) and Puri (2005).
• onset of mental disabilities is concentrated in childhood and 20-30, resulting in the lowest average age of onset. While more analysis is needed, it is assumed that MR is more focused on the earliest years and mental illness becomes more pronounced in young adulthood. • in contrast, visual disabilities are much more associated with ageing, with easily the oldest mean age of onset. While hearing disabilities exhibit a more pronounced dual peak, they are also on average subject to later average onset. • both locomotor and speech disabilities are more concentrated in younger ages also, with the highest onset in the early years of life in both cases, and a more noticeable second wave of onset for speech disabilities around age 60. Age at onset of mental disability Age at onset of visual disability Density 0 .005 .01 .015 .02 .025 Density 0 .01 .02 .03 0 20 40 60 80 100 Age at onset 0 20 40 60 80 100 Age at onset Age at onset of hearing disability 0 .005 Density .01 .015 .0 2 Age at onset of speech disability Density 0 .005 .01 .015 .02 .025 0 20 40 60 80 100 Age at onset 0 20 40 60 80 100 Age at onset Age at onset of locomotor disability Density 0 .01 .02 .03 .04 0 20 40 60 80 100 Age at onset Based on Das (2006), using NSS 58 th round 3.6. The age profile of onset reflects the differing structure of causes by disability category. While aggregate trends in disability cause discussed in Chapter 1 (i.e. transition from communicable to non-communicable causes, and increasing importance of injuries/accidents) are important, design of appropriate interventions also needs to focus on disability-specific profiles of causes. Critical periods for intervention for locomotor and speech disabilities are particularly in early childhood. For mental disabilities, the critical period for MR is also early childhood, while for mental illness, adolescence and early adulthood are key. For hearing impairments, screening throughout life seems important, but especially as people age, and for visual disabilities, the focus -34-
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PEOPLE WITH DISABILITIES IN INDIA:
Page 3 and 4:
Abbreviations and Acronyms ADL ANM
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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 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: Box 2.4: Raising awareness and chan
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
Page 105 and 106: part of the authorities to increase
Page 107 and 108: 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
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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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