People with Disabilities in India: From Commitment to Outcomes

the primary care and therapeutic needs of people with PWD. Surprisingly, this mode of service
delivery is missing from the PWD Act. CBR has been promoted with particular strength in south
India, often with initial international funding through NGOs. At the same time, CBR strategies
have constantly been evolving in response to changing needs, times and criticisms. Despite this,
CBR has to date been implemented in only around 100 (of around 600 total) districts, and only 6
percent of villages have coverage of rehabilitation services within 10 kilometres.
3.38. While there is no single CBR model, most CBR initiatives share a range of common
objectives and features, i.e. to: (i) deinstitutionalize medical care, working with PWD in their
communities; (ii) expand PWD access to rehabilitation services; (iii) demedicalize social
responses to disability and thereby help reduce social stigma; and (iv) shift investments away
from curative to preventive measures. The concept is institutionally flexible and can be
operationalized by communities, NGOs and government, separately or in partnerships. Local
level identification, training and technology development is encouraged, involving not only
disabled people and their families but teachers, healers and religious leaders.
3.39. There is also significant community outreach by hospitals and community institutions
for the disabled: Medical colleges, hospitals, schools of social work, and institutes of higher
education often have a community outreach programs for PWD. For instance, the renowned
cerebral palsy institutes started rural and slum outreach programs in the 1970s, where their staff
provided community-based services to children with CP and multiple disabilities. Several of
these outreach units developed into independent centers of community based rehabilitation.
Vidyasagar – an institute for children with multiple disabilities in Chennai, also has an ongoing
partnership with local hospitals and assessment centers to which it refers its clients. Its outreach
has also included links with specialized centers for specific disabilities.
C. Use of Health Services by PWD
3.40. As noted, there is relatively limited research on use of health services by PWD in India,
and the drivers of usage patterns. This section reports NSS data on overall use of health services
by PWD and more specifically access to aids and appliances. It also includes evidence from the
UP and TN village survey. Figure 3.4 outlines self-reported seeking of health treatment by PWD
in the previous [year] for 2002. 72 Overall, a large proportion of PWD – almost 80 percent –
sought some treatment in the previous [year]. Disaggregating by state, a few points emerge:
• overall, PWD in north-eastern states tended to have low use of health services, with Mizoram
and Arunachal Pradesh less than half the national average usage among PWD.
• broadly, states that are lagging in overall supply of health services also lag with respect to use
of services by PWD.
• the exception is Delhi, which has good services overall, but less than fifty percent of PWD
who sought any treatment.
72 The word “treatment” in the NSS 58 th round used to describe any assessment, diagnosis or rehabilitation
that PWD have sought.
-45-