People with Disabilities in India: From Commitment to Outcomes

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period is during a person’s 50s and early 60s. Overall, the importance of early identification and intervention can not be stressed enough. The specific conditions are discussed in turn below. 3.7. The main causes of visual disabilities are presented in Table 3.1, and are primarily agerelated, with cataract and other age-related issues being the chief causes. The major share of visual disability is thus preventable and occurs due to lack of treatment. In a national estimate, Dandona et al estimate that almost two-thirds of blindness is preventable or treatable. If there is no change in the current trend of blindness, the study estimates that the number of blind persons in India would increase to 24.1 million in 2010, and to 31.6 million in 2020. If effective strategies are put in place to eliminate cataract, blindness in 15.6 million persons would be prevented by 2020, and 78 million blind person-years. Similarly, if effective strategies are implemented to eliminate refractive error blindness and corneal disease/glaucoma, another 7.8 million persons would be prevented from being blind in 2020, and 111 million blind person-years. Table 3.1: Causes of Visual Disabilities (for Individuals with Single Disability (i.e Visual Only) Cause Percent Cataract 23.4 Old age 23.0 Corneal opacity/other eye errors 20.0 Not Known 9.8 Other 5.6 Glaucoma 5.3 Burns or injury 4.7 Small pox 4.1 Medical/surgical intervention 2.6 Childhood diarrhea 0.7 Sore eyes after first month 0.9 Source: Das (2006), based on NSS 58 th round. 3.8. The major cause for both speech and hearing disabilities is illness and disease, or in the case of speech disability, is not known. In addition, over 21 percent of all hearing disabilities are due to old age. The importance of non-specific causes in these categories (other illness, other, not known in the case of speech disabilities) highlights that disability is intrinsically related to other public health issues, and that increasing access to better quality care is an important step towards reducing disabilities. This has implications not only for prevention but for diagnostic facilities and technology, and referral and rehabilitation services. Table 3.2: Causes of Hearing and Speech Disabilities - 2002 Percent Cause - Hearing Disability Cause - Speech Disability Percent 21.3 Old age Voice disorder 12.6 18.6 Discharge Paralysis 11.9 8.7 Other Other 8.3 5.3 Burns and injury Burns and injury 0.9 2.1 Noise Cleft palate 4.5 1.6 Medical/surgical intervention Medical/surgical intervention 3.8 0.7 Rubella Mental illness 2.8 0.01 Not Known Hearing Impairment 1.6 23.0 Other illness Old age 1.1 Other illness 25.2 Not Known 21.7 Source: Das (2006), based on NSS 58 th round. -35-
3.9. Locomotor disability is the category which is undergoing the most rapid change in causal profile. As Table 3.4 shows, for the current group of locomotor disabled people, polio remains the highest single cause, accounting for almost a third of all locomotor disability. However, burns and injuries are also a major share, and once more non-specific causes account for over 20 percent of total. As will be seen, progress in reduction of new polio cases has been a public health success stories in India in recent years, so that the causes of locomotor disability are shifting significantly. Table 3.4: Causes of Locomotor Disability - 2002 Cause Percent Polio 30.9 Burns and Injury 28.5 Other illness and disease 12.7 Stroke 6.3 Not Known 4.5 Other 4.5 Arthritis 3.0 Old age 2.8 Leprosy 2.2 Medical/surgical intervention 2.2 Cerebral Palsy 2.1 TB 0.4 Source: Das (2006), using NSS 58 th round 3.10. As noted in Chapter 1, estimates of mental disabilities in India remain particularly problematic. This is driven by various challenges, including identification skills of health providers, families and surveyors, and stronger social stigma attached to such conditions. With such a caveat, the NSS-identified causes of mental disabilities are presented in Table 3.4, and more than any other category highlight that causes of mental disabilities remain little understood in 49 India. As noted, research by mental health organizations has found much higher rates of mental disabilities, with for example a meta-analysis estimated the prevalence of mental illness at 5.8 percent of the population. 50 Equally, suicide rates in India have risen significantly since the 1980s, from 7.5 to 10.3 per 100,000 population between 1987 and 51 Table 3.5: Causes of Mental Disability - 2002 Other 41.65 Not known 36.31 Serious illness in childhood 11.97 Head injury in childhood 3.83 Heredity 3.17 Pregnancy/birth related 3.01 Source: Das (2006), using NSS 58 th round 1997. Suicide rates also have notable state variations, with pockets of high prevalence for suicide, for example, in Kerala, West Bengal and Tamil Nadu. 52 Addressing mental health issues during and after disasters has also come into focus after the Bhopal gas leak, earthquakes in Marathwada and Gujarat, and more recently the tsunami for 2004. 3.11. A further cross-disability issue that is likely to assume greater importance over time is the prevalence of accidents and injuries as a cause of disability. Table 3.5 provides insights by gender from 2002 on where such accidents occur. Overall, using NSS sources, accidents and injuries have some role in around 18 percent of all disabilities. There are, however, major gender differences in the source of such injuries. For males, over 35 percent of these injuries are at the place of work, while for women, the overwhelming proportion – 60 percent - are in the home. 3.12. In addition, around 27 percent of male and 14 percent of female burns and injuries happen in transport accidents, confirming data from other sources of a major impact of road 49 As Gururaj and Isaac point out, psychiatric epidemiology suffers from particular methodological and definitional problems not only in India, making comparability of research more challenging. 50 Reddy and Chandrashekar (1998). 51 World Mental Health Report (2001). 52 Puri (2005). -36-
Page 1 and 2:
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
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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 and 62: Box 2.4: Raising awareness and chan
Page 63: • onset of mental disabilities is
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
Page 113 and 114: 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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