People with Disabilities in India: From Commitment to Outcomes

to the new asha workers under the National Rural Health Mission to schools and communities
themselves. A key need will be simple tools which allow for screening and referral of at-risk
infants and children. Pilot exercises underway in a number of developing countries provide a
model which is worthy of more systematic use in India, and has already been effective on a
localized basis in India through initiatives such as Samadhan’s community worker model of early
screening in poor areas of Delhi. The Ten Question Screening Instrument developed by WHO
based on extensive developing country pilots is outlined in Box 3.1.
3.46. (b) Attitudes and knowledge of health service providers: As with education,
provider attitudes to PWD can have significant impacts on their access to health services. This is
an area that to date has received less attention than attitudes among education professionals.
However, the limited available evidence indicates that provider attitudes seem to be a constraint
on PWD access to health services. Research from hospitals throughout Orissa found that less
than 40 percent of providers were aware of entitlements under the PWD Act, and that close to 40
percent of them considered PWD as a burden. In Gujarat, many village health workers did not
know that mental illness and retardation were disabilities. The existence of attitudinal barriers
receives support from the UP and TN survey also, which found that 16 percent of PWD did not
seek health services due to provider attitudes. In addition, field research from Karnataka and
Rajasthan indicates a generally low level medical awareness among health care providers of
disability issues, in particular with respect to mental health. 79 Finally, articulation of demand by
district and sub-national governments for health services for PWD is poor. This is partly due to
the fact that - in a system that is struggling to respond to overall health issues - disability has little
priority, and partly because disability is subsumed within the preventive programs.
3.47. (b) Attitudes and knowledge of health service providers: As with education,
provider attitudes to PWD can have significant impacts on their access to health services. This is
an area that to date has received less attention than attitudes among education professionals.
However, the limited available evidence indicates that provider attitudes seem to be a constraint
on PWD access to health services. Research from hospitals throughout Orissa found that less
than 40 percent of providers were aware of entitlements under the PWD Act, and that close to 40
percent of them considered PWD as a burden. In Gujarat, many village health workers did not
know that mental illness and retardation were disabilities. The existence of attitudinal barriers
receives support from the UP and TN survey also, which found that 16 percent of PWD did not
seek health services due to provider attitudes. In addition, field research from Karnataka and
Rajasthan indicates a generally low level medical awareness among health care providers of
disability issues, in particular with respect to mental health. 80 Finally, articulation of demand by
district and sub-national governments for health services for PWD is poor. This is partly due to
the fact that - in a system that is struggling to respond to overall health issues - disability has little
priority, and partly because disability is subsumed within the preventive programs.
79 Bhambani, op.cit. Low levels of knowledge among health care providers is not of course restricted to
disability, as recent studies even from urban centres such as Delhi have shown (Hammer and Das, 2005),
but the lack of knowledge on disability-specific issues appears particularly pronounced.
80 Bhambani, op.cit. Low levels of knowledge among health care providers is not of course restricted to
disability, as recent studies even from urban centres such as Delhi have shown (Hammer and Das, 2005),
but the lack of knowledge on disability-specific issues appears particularly pronounced.
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