People with Disabilities in India: From Commitment to Outcomes

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on these issues. It does not make specific additional commitments on treatment and rehabilitation of PWD. Secondly – in contrast to areas such as education and employment – the Act’s provisions on health are in the form of unenforceable commitments due to the rider “within the limits of [governments’] economic capacity and development”. As a result, respect to health issues and PWD, the Act remains largely aspirational even in principle with, mainly outlining the type of prevention and early detection initiatives that states should seek to implement. 3.32. Both policy and practice therefore indicate that the bulk of both prevention and treatment of disability will continue to happen as part of the broader public and curative health delivery systems. Equally, access to health for PWD will be characterized by a combination of elements common to all people (e.g. the effects of household income on access to care), as well as disability-specific needs and issues of access. There is thus a complex interaction of supply and demand side factors that come into play. Figure 3.3 sets out some of the linkages. 3.33. This section explores specific elements of the health delivery system which are of particular relevance to PWD. This includes initiatives that are specific to PWD in both the public and non-governmental/community sectors (e.g. disability certification), and some where interactions of PWD with the general health delivery system may raise issues above and beyond those of the general population. Figure 3.3: Demand and supply side linkages in health and disability Source: Das (2006) 3.34. (i) Dedicated PWD health services: Generally, the focus of PWD-specific public interventions has been on rehabilitation. Technological support on rehabilitation is provided by the five National Institutes on disability, set up in the 1970s and 1980s. 71 The mix and PWD coverage of services by the Institutes is presented in Table 3.9, which have serviced just over 1.8 mln. PWD in their existence. In recent years, India is placing an increased emphasis on social and community based approach. In early 1995, the Government launched the District Rehabilitation Center (DRC) Scheme as a model of comprehensive rehabilitation services to rural 71 The National Institute for the Visually Handicapped, Dehradun (1979); the National Institute for the Orthopaedically Handicapped, Kolkata (1978); National Institute for the Hearing Handicapped, Mumbai (1983); National Institute for the Mentally Handicapped, Secunderabad (1984) and National Institute for Multiple Disabilities (being set up in Chennai). The two apex level Institutes are the National Institute of Rehabilitation, Training & Research, Cuttack (1984) and the Institute for the Physically Handicapped, New Delhi (1976). -43-
PWDs. The scheme operates in 11 centers in 10 States. The objectives of the DRC include surveying the disabled population, prevention, early detection and medical intervention and surgical correction, fitting of artificial aids and appliances, therapeutic services - physiotherapy, occupational therapy and speech therapy, provision of educational services in special and integrated schools, provision of vocational training, job placement in local industries and trades, self-employment opportunities, awareness generation for the involvement of community and family to create a cadre of multi-disciplinary professionals to take care of major categories of disabled in the district. 3.35. There are 4 Regional Rehabilitation Training Centers (RRTC) that function under the DRC scheme which provide training to village level functionaries, DRC professionals, and State Government officials. They also conduct research in service delivery and low cost aids production. Apart from developing training material and manuals for field use, RRTCs also produce material for creating community awareness. A National Information Center on Disability and Rehabilitation was also established in 1987 to provide a database for comprehensive information on all facilities and welfare services for the disabled within the country. It acts as an agency for awareness creation, preparation/collection and dissemination of materials/information on disability relief and rehabilitation. Institution National Institute of Hearing Handicapped National Institute of Mentally Handicapped Table 3.9: Coverage of National Institutes for PWD by Type of Services Special Rehabilitation Extension Educators Services Services Trained Clinical Services Total PWD served 2,536 23,452 11,077 175,893 212,958 31,804 14,445 54,071 18,923 119,243 National Institute of − 23,487 65,083 221,804 310,374 Orthopedically Handicapped National Institute of 5,972 325,771 83,463 24,128 439,514 Visually Handicapped Institute for the Physically 619 22,090 47,201 65,652 135,562 Handicapped National Institute of 415 26,369 1,863 330,437 359,089 Rehabilitation Training and Research District Rehabilitation − 26,614 149,583 204,286 380,483 Centre/Regional Rehabilitation Training Centers Total 41,346 462,228 412,526 1,041,123 1,957,223 Source: Asia Pacific Development Center on Disability India Country Profile. 3.36. State governments have their own policies and schemes for PWD as well. These include institutes that are run by state governments and grants to NGOs that access schemes of the state governments. The issue of access to health services that are not rehabilitative in nature has been addressed only obliquely. For instance, the RCI has a program for the training of medical officers in Primary Health Centers. 3.37. Perhaps the most interesting set of services being offered to PWD in India are Community Based Rehabilitation (CBR), which has been effective in rural areas in addressing -44-
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
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Box 5.4: A Jobs Fair Bringing Emplo
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NGOs, both quantitative and qualita
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Out of school rates for CWD are hig
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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 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: almost three times more likely to h
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
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
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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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