People with Disabilities in India: From Commitment to Outcomes

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system and local health care providers (both public and private), is needed to improve early identification of disability and ensure more cost effective prevention and treatment. The TQSI probe methodology seems worth experimenting with in this respect. This effort needs to be accompanied by improved outreach and possibly simpler procedures for disability certification, including raising awareness that such a system exists. Given the serious supply side constraints, it also seems sensible to explore accreditation of qualified private health care practitioners for disability certification. While this is not without risks and would require a basic oversight mechanism, it seems a feasible way to address the major outreach problems of the public sector with respect to certification. 3.57. Minimizing the incidence and severity of disability: Cost effective interventions to minimize disability need to be strengthened, including iodization of salt (recently made mandatory once more), and micronutrient supplementation for children and pregnant women. This would include a reversal of declining immunization coverage (polio excepted), which is contributes to both disability and mortality rates. Current efforts such as provision of simple aids such as glasses or crutches also need to be expanded – in partnership with the private sector – to prevent mild impairments becoming serious disabilities which compromise learning, work, and other activities of daily life. The importance of simple interventions such as cataract surgery and hearing devices will also increase with an ageing population. However, other efforts will be needed beyond the health sector. Efforts to promote road safety are an important case, with the rapid expansion in accident-related disability. While the draft National Road Safety Policy is one step, greater efforts at the state level such as those being pioneered in Kerala and Tamil Nadu are needed to stem the major increase in traffic injuries and death. 3.58. Improving quality of care for disabled people: Key actions to be taken include (i) better integrating disability management in existing health delivery systems. Departments of social welfare, health and W&CD have to work together and in tandem with early intervention through the education system, NGOs and communities. This would include joint disability training for local level service providers and communities based on common mandates, combined with incentives and identification of influential champions. Improving training of PWD as health advocates and field facilitators is needed if they are to become active agents and not passive beneficiaries are also important; (ii) improved referral systems for the existing rehabilitation network, followed by increased funding and personnel (whose levels are currently at less than 10 percent of WHO standards for developing country rehabilitation services); (iii) a stronger distribution network for Government programs of aids and appliances, including awareness raising of among PWD and incentives schemes for producers; (iv) improved centers and resources devoted to disability management, including assessment, rehabilitative services and medical intervention Indian organizations have capacity to develop low cost technology for PWD, but need adequate funding and incentives, and finally, (iv) more aggressive efforts to develop government and NGO partnerships in all areas of disability services will be needed to strengthen service delivery; and finally (v) continued efforts to ensure that prevention of disabilities through immunization and other preventive measures is strengthened. 3.59. Addressing current and future provision and information gaps. New legislation and its enforcement are needed, particularly in the areas of mental health and road safety (including emergency care), both of which are increasingly important causes of disability. The aging of the population and attendant disability needs of the elderly will need to be addressed. Finally, data and statistics on disability need to be more reliably and regularly collected, in particular through strengthened NFHS and general health surveys, which have neglected disability. More specifically, India has some way to go in developing a robust injury surveillance system, -55-
including for road accidents, and examples such as Thailand’s National Injury Surveillance System introduced in 2003 provide useful lessons in this respect. 83 3.60. Given capacity constraints, improving the health sector’s response to disability may most feasibly happen in two phases. The first phase would concentrate on accelerated response closest to the community. This would include an improved certification system, promotion of CBR (including awareness raising and stigma reduction), and enhancing micronutrient supplementation (including food fortification) and immunization. The supply side interventions would need to include training of general duty medical officers in disability certification, and of community volunteers. The second phase would focus on improved referral systems between levels of the health system, including increased supply of therapists and support for establishment of therapy centers in rural areas. It would also likely involve networking of hospitals and specialized centres, possibly with support from the private corporate sector. 83 See WHO/World Bank, op.cit. -56-
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PEOPLE WITH DISABILITIES IN INDIA:
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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
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should move to implement the Act’
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54. Addressing current and future p
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disability SHGs, which has been sho
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have comparative advantage is putti
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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 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: 3.51. (f) Financial barriers to acc
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
Page 129 and 130: consistent with survey findings. Na
Page 131 and 132: exchanges are in any event servicin
Page 133 and 134: 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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People with Disabilities in India: From Commitment to Outcomes

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