People with Disabilities in India: From Commitment to Outcomes

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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-
Figure 3.4: Proportion of disabled seeking any treatment 2002 100 Proportion of Disabled Seeking Any Treatment 2002 Source: Author's calculation using NSS 58th Round 90 80 70 60 50 40 30 20 10 0 Chandigarh Lakshdweep Dadra &Nagar Punjab Have Pondicherry Daman &Diu Haryana Gujarat Jammu & Kashm Kerala Himachal Prades Goa Uttar Pradesh Uttaranchal Rajasthan Tamil Nadu Maharashtra Karnataka Nagaland Madhya Pradesh Andhra Pradesh Bihar West Bengal Assam Jharkhand Tripura Chattisgarh Meghalaya A&NIslands Orissa Manipur Delhi Sikkim Mizoram Arunachal Prades 3.41. NSS also allows examination of factors that affect the probability of PWD seeking treatment. The results are reported in Table 3.10, which reports the regression results on the probability of seeking treatment among specified categories of PWD relative to a series of reference category PWDs. 73 A number of interesting findings emerge: • being disabled from birth has a major impact on likelihood of having sought treatment, with those disabled from birth more than 70 percent less likely than those who acquired their disability later in life to have sought treatment. • women are around 13 percent less likely than PWD men to seek treatment. • higher levels of PWD education substantially increase the likelihood of seeking treatment. • PWD with locomotor conditions are the most likely to have sought treatment, while the other extreme is those with hearing and speech disabilities, who are less than half as likely as locomotor PWD to have sought treatment. • predictably, ST/SC/OB status has a negative effect on likelihood of seeking treatment, with ST in particular only half as likely to have sought treatment. This can be considered to be picking up broader income/welfare features which are not well captured in the data. • the north-east and eastern regions have easily the lowest likelihood of having sought treatment by PWD. The northern region in contrast has the highest likelihood of having sought treatment. • those in urban areas are 55 percent more likely to have sought treatment, reflecting not only the generally better access to health services, but also the disproportionately worse situation with respect to disability-specific rehabilitation and treatment services offered in rural areas. • PWD living with their parents are much more likely to have sought treatment. • several indicators had either statistically insignificant impacts on likelihood of seeking treatment, or significant but marginal impacts. These include the age of the PWD, whether or not they are married, household size, and amount of land possessed by the household. 73 Given the sampling of NSS disability module, such an exercise can not be performed relative to the general population, but only among the PWD sample. -46-
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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
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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
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government strategies for promoting
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Safety Net Schemes 33. Safety nets
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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 and 72: almost three times more likely to h
Page 73: PWDs. The scheme operates in 11 cen
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
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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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