Armut und Behinderung - Behinderung und Dritte Welt

16. JAHRGANGAUSGABE 2/2005Behinderungund Dritte WeltJournal for Disability and International DevelopmentSchwerpunktthema:Armut und BehinderungZeitschrift des Netzwerks Menschen mit Behinderung in der Einen Welt

INHALTInhaltsverzeichnisEDITORIAL..............................................45SCHWERPUNKTTHEMAArmut und BehinderungArmutsbekämpfung und BehinderungStefan Lorenzkowski................................................................46Poverty, Disability and Social Exclusion: NewStrategies for Achieving Inclusive DevelopmentConnie Laurin-Bowie.............................................................51Perspectives on Disability, Poverty and TechnologyDavid Seddon, Bill Albert, Rob McBride.............................57Applying the Minority Perspective to Disability inAfghanistanMajid Turmusani................................................................63Challenging International Development’sResponse to DisabilityTamsin Bradley..................................................................68Disabling Infant Hearing Loss in a DevelopingSouth African Community: the RisksD. Swanepoel/S.R. Hugo/B. Louw.........................................75BERICHTEEmpowerment and Disability: Reporting from theInternational DCDD Symposium Disability,Self-organisation and Aid.......................................................83VERANSTALTUNGEN............................85NEWSDemolition of poor people's homes and marketstalls in Zimbabwe..................................................................86bezev-Preis für wissenschaftliche Arbeiten zum ThemaBehinderung und Entwicklungszusammenarbeit..............86Wanderausstellung zu MDGs und Behinderung...............86Belgischer Senat verbietet Streubomben............................86"Treffpunkt Eine Welt"...........................................................87Stellenmarkt Global................................................................87Neue Datenbank vereinfacht Recherche zuentwicklungspolitischen Themen........................................87LITERATUR UND MEDIEN.....................87STELLENANZEIGEN..............................87Zeitschrift Behinderung und Dritte WeltWintgenstr. 63, 45239 EssenTel.: 0201/ 40 87 745Fax: 0201/ 40 87 748E-mail: Gabi.Weigt@t-online.deInternet: http://www.uni-kassel.de/ZBeh3WeltFür blinde und sehbehinderte Menschen ist die Zeitschriftals Diskette im Word-Format erhältlich.RedaktionsgruppeSusanne Arbeiter, HueCity/Vietnam sarbeiter@dng.vnn.vnProf. Dr. Adrian Kniel,Winneba/Ghana ucewlib@libr.ug.edu.ghHarald Kolmar, Marburg Harald.Kolmar@Lebenshilfe.deStefan Lorenzkowski, London stefan.lorenzkowski@web.deMirella Schwinge,Wien Mirella.Schwinge@univie.ac.atGabriele Weigt, EssenGabi.Weigt@t-online.deFachbeiratProf. Dr. Friedrich Albrecht, Görlitz || Dr. Niels-Jens Albrecht,Hamburg || Musa Al Munaizel, Amman/Jordanien || Dr.Mawutor Avoke, Winneba/Ghana || Beate Böhnke, Belem/Brasilien || Simon Bridger, Thalwil/Schweiz || Dr. WindyzFerreira, Joao Pessoa/Brasilien || Geert Freyhoff, Brüssel/Belgien || Ernst Hisch, Würzburg || Francois de Keersmaeker,München || Dr. Andreas König, Genf/Schweiz || Prof. Dr.Narajan Pati, Bhubaneswar/IndienSchriftleitungGestaltungGabriele WeigtLosocoRedaktionsassistenzThorsten LichtblauDruck und VersandBundesvereinigung Lebenshilfe e.V.BankverbindungBank für SozialwirtschaftKonto-Nr. 80 40 702, BLZ: 370 205 00BIC: BFSWDEE33IBAN: DE19 3702 0500 0008 0407 02Die Zeitschrift Behinderung und Dritte Welt ist einePublikation des Netzwerks Menschen mit Behinderungin der Einen Welt.Hinweis: Für den Inhalt der Artikel sind die Autor-Innen verantwortlich. Veröffentlichte Artikel stellennicht unbedingt die Meinung der Redaktion dar.Die Veröffentlichung von Beiträgen aus der Zeitschriftin anderen Publikationen ist möglich, wenn dies untervollständiger Quellenangabe geschieht und ein Belegexemplarübersandt wird.Die Zeitschrift Behinderung und Dritte Welt wird unterstütztdurch:- Bundesvereinigung Lebenshilfe e.V.- Kindernothilfe e.V.- Behinderung und Entwicklungszusammenarbeit e.V.- MisereorISSN 1430-589544Zeitschrift Behinderung und Dritte Welt 2/2005

EDITORIALLiebe Leserinnen und Leser!Zufällige oder aus fanatischen Gründen herausgewollte Ereignisse (Attentate) mit Folgen wieTod, Verletzung und Behinderung, können jede/jeden von uns zu jeder Zeit treffen, auch in der westlichenWelt. Das haben die Attentate in London inder jüngeren Vergangenheit deutlich gezeigt. Unvorstellbar,dass solche Folgen für ihre Mitmenschenvon den Tätern bewusst in Kauf genommen werden,gewollt werden. Dass solche Unvorstellbarkeitenfast jeden Tag in einem Land wie dem Irak geschehenund wir die Meldungen darüber wahrnehmen,gehört schon mehr oder weniger zur Tagesordnung.Diese Ereignisse sind auch beim Schreiben diesesEditorials wieder präsent.Behinderung in armen Ländern und dieAuswirkungen für die betroffenen Menschen undihre Familien, nicht nur als Folge von Unfällen undKatastrophen, der Zusammenhang von Behinderungund Armut, damit beschäftigt sich die aktuelleAusgabe unserer Zeitschrift in den Hauptbeiträgen.Wir greifen damit unter anderem ein Thema auf,welches insbesondere im Dialog zwischen NGOsund politischen Ebenen (Weltbank, UN etc.) verstärktzum Tragen kommt. Armutsreduzierung ist einpolitisches Ziel, das vielfach bemüht wird.Stefan Lorenzkowski geht in seinem übergreifendenBeitrag zunächst auf den Zusammenhang zwischenArmut und Behinderung ein, fokussiert dannauf Ansätze zur Armutsreduzierung verschiedenerinternationaler Organisationen und (Regierungs-)ebenen, sowie auf Kooperationen von NGOs und dieEntwicklung politischer Strategien.Aus Sicht einer international tätigen NGO fürMenschen mit geistiger Behinderung – InclusionInternational – stellt Connie Laurin-Bowie dieNotwendigkeit dar, von einer spezifischen Behindertenpolitikzu einer inklusiven Politik zu wechseln,um so die Lage behinderter Menschen weltweitpositiv verändern zu können. Inclusion Internationalbaut hierbei auf das Know-how ihrer Mitgliedsorganisationenin über 100 Ländern.Bill Albert, Rob McBride und David Seddon stellenin ihrem Beitrag eine Beziehung zwischenBehinderung, Armut und Technologie in Entwicklungsländernher, sehen aber auch in der Armutsreduzierungeinen möglichen positiven Einfluss aufden Umgang mit und die Folgen von Behinderung.Zeitschrift Behinderung und Dritte Welt 2/2005Tamsin Bradley kritisiert westliche Organisationen,die im Bereich Behinderung in Entwicklungsländerntätig sind, dergestalt, dass sie zu sehr westlicheModelle applizieren und zu wenig lokales (indigenes)Wissen und Unterstützungsstrategien wertschätzen.Diese Kritik stellt Bradley auch in denZusammenhang von Armut und Behinderung undverdeutlicht seine Erfahrungen an einem konkretenBeispiel.Majid Turmusani betrachtet die aktuelle Situationvon Menschen mit Behinderung in Afghanistanaus verschiedenen Blickwinkeln. Hierbei wirdnicht explizit auf Armut und Behinderung eingegangen,was aber diesen interessanten Beitrag in keinsterWeise schmälert.De Wet Swanepoel et al beschäftigt sich in seinemArtikel mit dem Zusammenhang von Hörschädigungund den Folgen für die betroffenenMenschen, für die Familien und die Gesellschaft amBeispiel einer Studie in einer Gemeinde in Südafrika.Dabei wird auf die Zusammenhänge zwischenregionaler (defizitärer) Entwicklung, Wohn- undLebensverhältnissen unter Armutsbedingungen undderen Einfluss auf Hörschädigungen eingegangen.Auch dieses Mal wieder bitten wir unsereLeserschaft um Rückmeldungen sowohl zu denBeiträgen der einzelnen Ausgaben als auch zu derZeitschrift allgemein, um so Ihre Einschätzungen infolgende Ausgaben mit einfliessen lassen zu können.Bitte denken Sie auch daran, die Erstellung derZeitschrift mit einer Spende ab 10 Euro pro Jahrfinanziell zu unterstützen. Für Überweisungen ausdem Ausland sind die Angaben zur Bankverbindungentsprechend ergänzt worden.Sie helfen uns ebenfalls sehr, wenn Sie ÄnderungenIhrer Bezugsadresse rechtzeitig an uns melden.Das erspart unnötige Kosten auf unserer Seite.Vielen Dank, und gute Lektüre wünschtIhre Redaktionsgruppe45

SCHWERPUNKTTHEMAArmutsbekämpfung und BehinderungObwohl behinderte Menschen 1 in den letztenJahren in der Arbeit von Nichtregierungsorganisationen(NROs) einen größeren Stellenwert eingenommenhaben, ist Behinderung in der Entwicklungszusammenarbeitimmer noch ein Randthema,das im Vergleich zu Fragen von HIV/Aids oderGender wenig Aufmerksamkeit erhält. EineSchwierigkeit in diesem Zusammenhang ist, dassBehinderung im Zusammenhang mit Armutsbekämpfungeine große Komplexität aufweist und dieBerücksichtigung anderer Aspekte notwendigmacht. Eine Reihe NROs, wie Action in Disabilityand Development, Handicap International oderOxfam sehen Behinderung inzwischen als einQuerschnittsthema an, das im besten Fall alleBereiche der Entwicklungskooperation einbezieht.Zwischen Behinderung und Armut besteht ein engerZusammenhang, insbesondere wenn man denBegriff der Armut nicht ausschließlich wirtschaftlichdefiniert. Armut ist ein Zustand, in dem ein Zusammenspielvon Mangelzuständen zu einem sehr geringenLebensstandard oder auch zu lebensbedrohlichenZuständen führen kann. Schlechte Ausbildung,mangelnde Gesundheitsversorgung, fehlende politischeTeilhabe und Diskriminierung sind für Armutebenso charakteristisch wie ein geringes Einkommen.Für behinderte Menschen kommen weiterhinfehlende Rehabilitation und Hilfsmittel für denAlltag hinzu. Da sie mehr Aufmerksamkeit von anderenFamilienmitgliedern benötigen, um den Alltagzu organisieren (z.B. tägliche Pflege, Gänge zumArzt, Unterstützung im Transport etc.), kann eszudem dazu kommen, dass das Familieneinkommenbeeinträchtigt wird.Der gegenseitige Einfluss von Armut auf Behinderungund umgekehrt ist weltweit zu beobachten,am deutlichsten aber in Entwicklungsländern erkennbar.In Europa und Nordamerika bieten diesozialen Systeme zurzeit noch genügend Schutz fürBehinderte und ihre Familien. Zudem werden behinderteMenschen dort durch Antidiskriminierungsgesetze– zum Beispiel auf dem Arbeitsmarkt –geschützt. Es wird aber auch deutlich, dass in ZeitenStefan LorenzkowskiMenschen mit Behinderung werden bis heute in den internationalen Bemühungen zur Armutsbekämpfung nicht ausreichendberücksichtigt. Ein Beispiel hierfür sind die Millennium Development Goals (MDGs) der Vereinten Nationen, indenen behinderte Menschen keine Erwähnung finden. Seit dem Jahr 2000 sind allerdings in nationalenEntwicklungsministerien und internationalen Organisationen wie der Europäischen Union oder der Weltbank Initiativenentstanden, die auf eine Einbeziehung von Menschen mit Behinderung in die Strategien zur Armutsbekämpfung drängen.In Entwicklungsländern selbst sind Ansätze zur Reduzierung der Armut von behinderten Menschen in einzelnenProjekten bereits sichtbar. Der Artikel will einen Überblick über die gegenwärtig existierenden Initiativen geben, ohneden Anspruch zu erheben, vollständig zu sein.wirtschaftlicher Krise der Staat nicht davor zurückschreckt,behinderten Menschen die Unterstützungzu beschneiden.In Entwicklungsländern ist die Situation völliganders. Hohe Arbeitslosigkeit, soziale Systeme mitwenig bis gar keinen Schutzmechanismen fürgefährdete Bevölkerungsgruppen, unzureichendeGrundversorgung mit Elektrizität oder Wasser undKorruption in den Behörden stellen für Behinderteeine existenzielle Bedrohung dar.Die folgende Schilderung verdeutlicht, dass allgemeineEntwicklungsziele im Bereich ArmutsbekämpfungBehinderung berücksichtigen müssen.Ohne dies wird es nicht möglich sein, gesteckteZiele oder Strategien der Entwicklungskooperation(wie die MDGs oder die PRSPs) zu verwirklichen.Behinderung und Armut – Zahlen undFaktenIm Laufe der letzten Dekade haben eine Reihevon Wissenschaftlern und Organisationen dieZusammenhänge von Behinderung und Armutuntersucht. Die Forschungslage über behinderteMenschen in Armutslagen ist nach wie vor dürftig.Als positives Beispiel ist der Bericht des ChronicPoverty Research Centres hervorzuheben (2004), indem ausführlich Bezug zum Thema Behinderunggenommen wird. Auch die Weltbank (z.B. Elwan1999) hat Studien veranlasst, die die Situation vonarmen Menschen mit Behinderung thematisieren.Sowohl die Zahl von behinderten Menschen wieauch die Zahl von in Armut lebenden Menschen lassensich schwer bestimmen. Die Weltgesundheitsorganisation(WHO) geht davon aus, dass weltweitca. 10% der Bevölkerung eine Behinderung haben.In diesem Artikel werden diese Schätzungen alsGrundlage genommen. Bei einer Weltbevölkerungvon ca. 6 Milliarden Menschen haben demnach 600Millionen Menschen eine Behinderung, von denenbis zu 480 Millionen in Entwicklungsländern leben.Ebenfalls nur Schätzungen gibt es über die Anzahlvon Menschen, die unter Armut leiden. Die Welt-46Zeitschrift Behinderung und Dritte Welt 2/2005

SCHWERPUNKTTHEMAbank vermutete 2001, dass 21% der Weltbevölkerung(ca. 1,26 Milliarden) in Armut (weniger als$2 pro Person und Tag) oder absoluter Armut (wenigerals $1 pro Person und Tag) leben.Die Zahl behinderter Menschen, die in Armutleben, ist schwer zu bestimmen. Elwan (1999)nimmt an, dass einer von fünf armen Menschen inEntwicklungsländern eine Behinderung hat (ca. 317Millionen). Da wie bereits erwähnt, ein behindertesFamilienmitglied mehr Aufmerksamkeit erfordertund die Familie als Einheit von Behinderung betroffenist, dürfte die Zahl von Menschen, die von denFolgen einer Behinderung betroffen sind, noch vielhöher liegen. Elwan hebt hervor, dass eine direkteBeziehung zwischen der Existenz einer Behinderungund dem Familieneinkommen besteht.Ein BeispielIn einer von der Weltbank geförderten Studie inUganda (Hoogeveen 2004) wurden die Auswirkungender Existenz von behinderten Familienmitgliedernauf die ökonomische Situation ihrer Familienherausgearbeitet. Basierend auf einer statistischenErhebung aus dem Jahr 1991 stellt Hoogeveen fest,dass 5% aller Haushalte in Uganda einen behindertenHaushaltsführer haben. Diese Haushalte sind inder Regel größer als vergleichbare Haushalte ohneein behindertes Familienoberhaupt. Außerdem habendie behinderten Familienoberhäupter eine geringereAusbildung, sind häufiger Analphabeten und invielen Fällen weiblich. Im Zusammenhang mit dersanitären Versorgung fiel auf, dass diese Haushalteweniger Zugang zu fließendem Wasser und Toilettenhaben. Zudem ist mehr als die Hälfte von Haushaltenmit behinderten Familienoberhäuptern daraufangewiesen, mit Kohle anstelle von Gas oder Benzinzu kochen. Bezüglich des Arbeitsmarktes befindensich behinderte Menschen in Uganda in einer schlechterenSituation. Zusammenfassend lässt sich feststellen,dass Haushalte mit behinderten Familienmitgliedernbesonders gefährdet sind, von Armut betroffen zusein. Die daraus resultierenden Risiken betreffen dasFamilieneinkommen, die Ausbildungschancen fürKinder, medizinische und rehabilitative Versorgungund politische Partizipation. Diese Befunde verdeutlichen,dass Behinderung im Zusammenhang mit anderenFeldern der Entwicklungskooperation angegangenwerden muss, um nachhaltige Erfolge zu erzielen.Zeitschrift Behinderung und Dritte Welt 2/2005Zusammenhänge zwischen Armut undBehinderungRebecca Yeo (2001) unternahm mit ihrer Studieden Versuch, die Zusammenhänge zwischen Behinderungund Armut darzustellen. Sie arbeitete deutlichdie Verflechtungen der verschiedenen EbenenBeeinträchtigung, Gesundheit, Umwelt, Diskriminierung,wirtschaftliche Aspekte und Menschenrechteheraus. Es wird immer wieder betont, dassBeeinträchtigungen einerseits durch Armut ausgelöstwerden können. So kann z.B. Mangelernährungeiner schwangeren Frau direkt eine Behinderung desneugeborenen Kindes bewirken. Andererseits kannBehinderung umgekehrt auch Armut hervorrufen,wenn sie nämlich zum Beispiel zur Folge hat, dassdie behinderte Person keine Arbeitsstelle erhält. Esist nicht immer klar, welches die primäre Ursacheeiner Behinderung oder der Armut ist, sondernBehinderung und Armut müssen in einem wechselseitigenWirkungsgeflecht gesehen werden.Die Gefahr dieser Darstellung liegt allerdingsdarin, dass die Zusammenhänge zwischen Behinderungund Armut durch Zirkelschlüsse vereinfachtwerden (Nohlen 1996) und so die Erschließung derdirekten Ursachen im Rahmen der lokalen Gegebenheitenschwierig gemacht wird. Im Alltag derEntwicklungsarbeit kann diese Vereinfachung derZusammenhänge zu Schwierigkeiten führen undProjektziele plausibel erscheinen lassen, die langfristignicht zu einer wesentlichen Verbesserung derArmutssituation führen können.An dieser Stelle soll kein Alternativmodell vorgestelltwerden, sondern der Stellenwert holistischerModellen hervorgehoben werden, die es ermöglichen,die Wechselwirkungen zwischen einzelnenTeilbereichen zu erkennen, die auf den ersten Blickaußerhalb der direkten Ursachen liegen.Ansätze zur Armutsbekämpfung beiMenschen mit BehinderungTwin Track ApproachIm Rahmen der Entwicklungszusammenarbeitgibt es eine Reihe von Ansätzen, die Armut unterbehinderten Menschen zu reduzieren. Der populärsteAnsatz ist der Twin Track Approach, der von derEuropäischen Kommission und vom britischenDepartment for International Development (DFID)vertreten wird. Durch diesen Ansatz sollen Menschenmit Behinderung einerseits in allgemeine Projekteund Programme der Entwicklungskooperationeinbezogen werden, andererseits aber auch direktgefördert werden. Die Einbeziehung behinderterMenschen in allgemeine Projekte betrifft sowohl dieZielgruppenorientierung als auch die Teilhabe anPlanungsprozessen. Dies soll die Ungleichheitenzwischen behinderten und nicht behinderten Menschenausgleichen. Die Förderung der Fähigkeitenbehinderter Menschen in speziellen Projekten solldiesen ermöglichen, sich selbständiger in das Leben47

SCHWERPUNKTTHEMAder Gemeinschaft einbringen zu können.Community Based RehabilitationEin weiterer Ansatz zur Reduzierung von Armutbehinderter Menschen sind gemeinwesenorientierteAnsätze wie Community-Based Rehabilitation(CBR) oder Community Approaches to Handicap inDevelopment (CAHD). In der Neuauflage des JointPosition Papers aus dem Jahr 2004 von WHO, ILOund UNESCO wird deutlich hervorgehoben, dassCBR als partizipativer Ansatz im Rahmen der lokalenEntwicklungsarbeit angewendet werden kann,um behinderte Menschen aus Armutslagen herauszuführen.Durch lokale, in der Gemeinschaft verwurzelteAktivitäten im Bereich der Rehabilitation,Ausbildung und Beschäftigung werden behinderteMenschen direkt in Maßnahmen der Armutsbekämpfungmit einbezogen.Beide hier erwähnten Ansätze sehen sowohlArmut als auch Behinderung als soziale Phänomene,die durch verschiedene Schritte und Aktivitäten zwarnicht komplett beseitigt werden können, denen aberdoch entgegengewirkt werden kann.Initiativen internationaler InstitutionenGlobal Partnership for Disability and Development(GPDD)Für die meisten internationalen Organisationen,die im Bereich der Armutsbekämpfung aktiv sind,hat das Thema Behinderung keine hohe Bedeutung.Behinderung sei ein Thema für Spezialisten wieTherapeuten oder Mediziner, hört man hier des Öfteren.Häufig wird argumentiert, dass Behinderungkeine Priorität in der Armutsbekämpfung sei, da sichdie allgemeinen Strategien zur Armutsreduzierungautomatisch auf behinderte Menschen auswirkenwürden. In fast allen multinationalen Geberorganisationenwerden die engen Zusammenhänge zwischenBehinderung und Armut vernachlässigt.Eine der wichtigsten und am meisten kritisiertenOrganisationen im Bereich der Entwicklungszusammenarbeitist die Weltbank. In den letzten fünfJahren hat hier ein Umdenken stattgefunden. DieErnennung von Judy Heuman zum World BankAdvisor on Disability and Development führte zueiner langsamen Sensibilisierung für die Bedürfnissevon behinderten Menschen in der Weltbank.Mitarbeiter von Judy Heuman bemängeln allerdings,dass Behinderung von einem Großteil der Weltbank-MitarbeiterInnen immer noch nicht ernst genommenwird.Ein wesentliches Ergebnis der Aktivitäten derWeltbank im Bereich Behinderung ist die GlobalPartnership for Disability and Development48(GPDD). Die Zielsetzung von GPDD ist, der wirtschaftlichenund sozialen Entwicklungskooperationeine Behinderungskomponente hinzuzufügen. Durchdie Bekämpfung ihrer Ausgrenzung soll der Verarmungvon behinderten Menschen entgegen gewirktwerden. GPDD basiert auf drei Schwerpunkten:- einer offenen und informellen Allianz aller beteiligtenOrganisationen und Staaten;- einer finanziellen Unterstützung, die von verschiedenenGeldgebern geleistet wird, und- einer Leitungsgruppe, die die Arbeit von GPDDkoordiniert.GPDD ist so angelegt, dass verschiedene Teilhabereinbezogen werden können, wie z.B. NROs, Regierungen,bi- und multilaterale Geldgeber, DPOs undauch Unternehmen. Das Wesentliche an diesem Ansatzist, dass keine neuen Strukturen geschaffen werden,sondern Behinderung in existierende Ansätzeeinbezogen wird. Inwieweit sich das GPDD aufMenschen mit Behinderung auswirken wird, ist nochnicht absehbar.Poverty Reduction Strategy Papers (PRSPs)Die zusammen von einzelnen Regierungen undder Weltbank koordinierten Poverty ReducationStrategy Papers (PRSPs) sind ein weiteres Beispiel,an dem die Schwierigkeiten des Mainstreaming vonBehinderung deutlich werden. In den meisten Fällenhaben die PRSPs keinen speziellen Bezug zuBehinderung. Behinderung wird meistens nur imZusammenhang von sozialer Sicherung gesehen undnicht unter den Aspekten von Empowerment oderInclusion.Eine positive Ausnahme ist in diesem Zusammenhangdas PRSP für Malawi. 2 Behinderte Menschenwerden darin als eine Zielgruppe erwähnt, diebesonders von Armut betroffen ist. Dies ermöglichtdie gezielte Einbeziehung von behinderten Menschenin die einzelnen armutsrelevanten Bereichewie Bildung, Gesundheit, soziale Absicherung undallgemeine Lebensqualität. Im offiziellen Fortschrittsberichtvom Februar 2005 werden allerdingsnur die Verbesserungen im Bereich der höherenBildung erwähnt. Dies zeigt die Notwendigkeit,Behinderung gezielt in PRSPs anzusprechen, umdamit einerseits ein Bewusstsein für Behinderungund andererseits Verpflichtungen für Staaten zuschaffen, die erfüllt werden müssen.Millennium Development Goals (MDGs)Auf dem Millenniumsgipfel im Jahr 2000 habensich die Staats- und Regierungschefs mit denMillennium Development Goals (MDGs) dieHalbierung der Armut bis 2015 als Ziel gesetzt. Hier,wie auch im Falle der meisten PRSPs der Weltbank,Zeitschrift Behinderung und Dritte Welt 2/2005

SCHWERPUNKTTHEMAwird nicht gesondert Bezug auf Behinderunggenommen. Inclusion International nahm dies alsAnlass, behindertenspezifische MDGs aufzustellen,um die Forderungen von Behindertenorganisationennachvollziehbar zu machen.UN-Konvention für die Rechte behinderterMenschenDas Department for Economic and Social Affairs(DESA) der Vereinten Nationen ist eine weitere UN-Institution, die im Bereich Behinderung nicht übersehenwerden darf, da sie mit der Aufgabe betrautist, zusammen mit dem UN Menschenrechtskommissariatdie Konvention für die Rechte behinderterMenschen voran zu treiben. Armutsbekämpfung istnicht als spezieller Artikel in dieser Menschenrechtskonventionvorgesehen. Dennoch gibt es verschiedenePunkte, an denen Armutsbekämpfung verhandeltwird. So sind die in der Konvention repräsentiertenKonzepte der Nichtdiskriminierung (Artikel7), Teilhabe (Artikel 4 und 18) und Repräsentierung(Artikel 2 und 4) wichtige Elemente, die eineeffektive Armutsbekämpfung bei behinderten Menschenermöglichen können. Durch die Verpflichtungzur Internationalen Kooperation bietet auch Artikel24bis ein Potenzial für Armutsbekämpfung. Er stelltdie Grundlage für Inclusive Development und dieStärkung lokaler Strukturen.Die Allianz von Behindertenorganisationen(International Disability Caucus, IDC) fordertebeim fünften Ad-Hoc-Meeting im Februar 2005,zum einen in der Entwicklungszusammenarbeitkeine nicht zugänglichen Infrastrukturprojekte mehrzu finanzieren, zum anderen mehr Ressourcen fürbehinderte Menschen bereit zu stellen. Inwieweitdiese Forderungen in die endgültige Version desKonventionstextes eingehen werden, wird sich währendder nächsten Treffen in New York zeigen.BIWAKO Millennium FrameworkEin positives Beispiel für die direkte Einbeziehungvon behinderten Menschen in regionaleStrategien zur Armutsbekämpfung ist das Asien- undPazifik-Referat der Vereinten Nationen (UNESCAP). Im Rahmen der Asiatischen und PazifischenDekade für behinderte Menschen wurde dasso genannte BIWAKO Millennium Framework fürdie Schaffung einer inklusiven, zugänglichen undrechtsbasierten Gesellschaft für behinderte Menschenverabschiedet. In dieser Richtlinie werden diewesentlichen Aspekte für die Einbeziehung behinderterMenschen genannt und die asiatischen undpazifischen Staaten aufgefordert, diese in ihreGesetzgebung aufzunehmen. Armutsbekämpfungsoll vor allem durch Kapazitätsaufbau, sozialeZeitschrift Behinderung und Dritte Welt 2/2005Sicherheit und nachhaltige Entwicklung erfolgen.UN ESCAP kooperiert aktiv mit den verschiedenenregionalen und nationalen Behindertenorganisationen(DPOs) und erreicht somit einen enormenEinfluss auch auf die nationalen Strategien zurArmutsbekämpfung. Die Aktivitäten in Indien oderBangladesch sind erfolgreiche Beispiele.Guidance Note on Disability and Developmentund Länderstrategiepapiere der EUEine andere internationale Ebene, die sich mehrund mehr auch mit Behinderung beschäftigt, ist dieEuropäische Union. 2003 wurde die Guidance Noteon Disability and Development for EU Delegationsand Services verabschiedet, die den Delegationender Direktion Entwicklung Richtlinien vorgibt, wiebehinderte Menschen in ihre Arbeit einbezogen werdenkönnen. Trotz der ambitionierten Ziele hat sichdieses Dokument in den verschiedenen Ländernnicht durchgesetzt. Vielfach ist nicht einmal seineExistenz bei den Delegationen der EuropäischenKommission bekannt.Eine weitere Möglichkeit, Behinderung in die allgemeineEntwicklungszusammenarbeit einzubeziehen,bieten die Länderstrategiepapiere (LSP) derEU. In 19 dieser LSP werden behinderte Menschenimmerhin erwähnt, aber nur in vier von ihnen werdendirekte Hilfen für Menschen mit Behinderungvorgeschlagen.Disability Knowledge and ResearchNeben den internationalen Organisationen habenauch einige nationale Entwicklungsministerien imLaufe der letzten Jahre Behinderung in ihre Arbeiteinbezogen. An erster Stelle ist hier DFID inGroßbritannien hervorzuheben. Im Jahr 2000 veröffentlichtedas DFID das Strategiepapier Behinderung,Armut und Entwicklung, das als eines derersten Dokumente den Twin Track Approach erwähnte.Seit diesem Zeitpunkt finanziert DFID dasForschungsprogramm Disability Knowledge andResearch, das den Zusammenhängen von Armut,Behinderung und Technologie nachgeht. Unter anderemwurden durch dieses Programm Forschungsprojektein Auftrag gegeben, die einerseits Behinderungin einigen Entwicklungsländern untersuchenund andererseits die globale Strategie von DFID imHinblick auf Behinderung auf den Prüfstand stellen.Hier zeigte sich, dass es erfolgreiche Kooperationenzwischen den DFID-Länderbüros und DPOs aufdem Balkan, in Russland und Indien gibt. Außerdemgibt es eine verstärkte Zusammenarbeit mit NROswie Action on Disability and Development, die langfristigund projektunabhängig unterstützt werden.Auf der anderen Seite ist zu beklagen, dass auch im49

SCHWERPUNKTTHEMADFID Behinderung nicht ein zentraler Aspekt derArbeit ist, wie z.B. Gender oder HIV/Aids, sondernin die Abteilung Menschenrechte integriert ist.FazitDie Reduzierung der Armut unter behindertenMenschen setzt Kooperationen auf verschiedenenEbenen voraus. Einerseits müssen internationale undnationale Entscheidungsträger ein Umfeld schaffen,in dem Behinderung mitgedacht wird. So könnenAspekte von Behinderung in allgemeine Programmeund Richtlinien einfließen. Ohne die Unterstützungauf der internationalen und nationalen Ebene wird esschwer für Interessengruppen behinderter Menschen,ihre Anliegen durchzusetzen.Andererseits müssen lokale und regionale Behördendirekt mit lokalen NROs und DPOs zusammenarbeiten,damit die Richtlinien sinnvoll umgesetztwerden können. Dies beinhaltet die volle Einbeziehungvon behinderten Menschen und Behindertenorganisationenauf lokaler Ebene.Daneben müssen nicht behinderte Menschen fürdas Thema Behinderung sensibilisiert werden. Dieskann durch die Menschen mit Behinderung in ihrenlokalen Kontexten erfolgen, durch speziellesTraining für Angestellte verschiedener Behördenund Institutionen, aber auch durch breit angelegteregionale Kampagnen wie im Rahmen der asiatischenund pazifischen Dekade der Menschen mitBehinderung.Anmerkungen1 In diesem Artikel wird vorwiegend der Begriffbehinderte Menschen verwendet. Dadurch solldeutlich gemacht werden, dass diese Bevölkerungsgruppedurch äußere Umstände behindertwird und Behinderung kein individuellesMerkmal ist (wie es z.B. in dem AusdruckMenschen mit Behinderung den Anschein hat).2 http://povlibrary.worldbank.org/files/Malawi_PRSP.pdfLiteraturCHRONIC POVERTY RESEARCH CENTRE: TheChronic Poverty Report 2004-2005, Manchester 2004DEPARTMENT FOR INTERNATIONAL DEVELOP-MENT: Disability, poverty and development, London2000ELWAN, Ann: Poverty and disability: a survey of the literature,Washington 1999EUROPÄISCHE KOMMISSION: Guidance note on disabilityand development for EU delegations and services,Brüssel 2003HELANDER, Einar: Prejudice and dignity, New York,1998HOOGEVEEN, Johannes: Measuring welfare for smallbut vulnerable groups: poverty and disability inUganda, Washington 2004NUSCHELER, Franz: Lern- und Arbeitsbuch Entwicklungspolitik,Bonn 1995UNESCAP: Biwako millennium framework for action,Bangkok 2003WORLD HEALTH ORGANISATION: CBR: a strategyfor rehabilitation, equalization of opportunities, povertyreduction and social inclusion of people with disabilities- joint position paper 2004, Genf 2004YEO, Rebecca: Chronic Poverty and Disability, Frome,2001Summary: Disabled people have not been considered sufficientlywithin the context of international cooperation.One example are the Millennium Development Goals, thatdo not take disability into consideration. Since 2000 anumber of international initiatives try to include disabilityinto their poverty reduction strategies. This article summarizesthe current situation without claiming to considerall existing initiatives.Résumé: Les personnes handicapées ne sont pas, jusqu'àprésent, suffisamment prises en considération dans lesefforts internationaux pour la lutte contre la pauvreté. Unexemple de cela sont les Millenium Developments Goals(MDGs) des Nations Unies dans lesquelles les personneshandicapées ne sont pas mentionnées. Depuis l'année2000, cependant, des initiatives ont vu le jour dans lesministères nationaux du développement et les organisationsinternationales telles que l'Union Européenne ou laBanque Mondiale. Ces initiatives exigent l'intégration despersonnes handicapées dans les stratégies de la lutte contrela pauvreté. Même dans les pays en voie de développementde légères améliorations concernant la réductionde pauvreté de personnes handicapées sont visibles.L'article veut donner un aperçu des initiatives existantes àl'heure actuelle sans pour cela prétendre être intégral.Resumen: Las actividades internacionales de la luchacontra la pobreza todavía no toman en cuenta adecuadamentea las Personas con Discapacidad. Sin embargo,desde el año 2000, en diferentes ministerios nacionales dedesarrollo y organizaciones internacionales como laComunidad Europea y el Banco Mundial se desarrollaroniniciativas para la inclusión de este grupo en las estratégiasde la lucha contra la pobreza. En los países en viasde desarrollo ya son notables los primeros programaspara reducir la pobreza de Personas Discapacitadas.Autor: Stefan Lorenzkowski arbeitet als DisabilityInformation Officer von Handicap International UK beiSource, einem internationalen Informationszentrum inLondon.Anschrift: SOURCE - International InformationSupport Centre, 2nd floor, Institute of Child Health, 30Guilford Street, London, WC1N 1EH, Großbritannien,E-Mail: S.Lorenzkowski@ich.ucl.ac.uk50Zeitschrift Behinderung und Dritte Welt 2/2005

SCHWERPUNKTTHEMAPoverty, Disability and Social Exclusion: New Strategies for AchievingInclusive DevelopmentConnie Laurin-BowieDespite international investments in development initiatives targeted to people who have a disability – investments bydomestic governments in support to people who have a disability and commitments by governments to internationaland domestic human rights commitments – little if any progress has been made in improving the economic, political orsocial status of people who have a disability in developing countries. To understand why people with disabilities continueto be among the most disadvantaged people in the world we must consider how people with disabilities are perceivedby policy makers and how development policy addresses disability. If real progress is to be made in achieving betterlives for people with disabilities both the perception of people with disabilities and our policy objectives mustchange. This paper outlines the need for a shift from disability policy to inclusive development policy and proposes thatcivil society organizations require expanded strategies to contribute to this shift. The global strategy developed byInclusion International to promote the inclusion of people with intellectual disabilities and their families in the UNMillennium Development Goals illustrates what this shift means for an international disability organization and demonstrateshow we can “link local voices to global change”.Disability has traditionally been characterizedand diagnosed primarily as a condition requiringmedical attention and rehabilitation – anassumption that has led to care and treatment basedon treating individual deficits. The widespread creationof specialized and separate services for personswith a disability including special education andvocational training are the legacy of this approach.A 1997 study commissioned by the Inter-American Development Bank indicated servicecoverage in Central America was less than 3%, between1.5% and 15% depending on the country.Strategies to create more traditional services cannotachieve significant coverage of people who have adisability particularly in countries where the projectedpopulation of people who have a disability isexpected to make up the majority of the population(as in some African countries).Moreover, these services and investments havenot proven effective in improving the well being ofpeople who have a disability. Over and over investmentsin disability initiatives have focused on theprovision of therapies or services which are intendedto ameliorate the impact of a disability either by preventingthe disability; providing rehabilitation, aidsor services. There has been less investment in thesupports needed for people to participate in the social,economic, political and cultural life of theirsocieties. Even where such supports have been provided,there has been inadequate investment inschools, health care, and child development schemesto ensure they are designed to be inclusive.Few initiatives which have as their objective theinclusion of people who have a disability have focusedon changing the systems in which a personwith a disability is attempting to participate in –classrooms; work environments; communities, etc.Investments continue to focus almost exclusively onthe disability with little or no effort being made tobuild inclusive systems.While the disability movement has evolved overtime to reflect a human rights approach to disabilityissues (rejecting the medical model of disability), theinternational human rights community has becomeincreasingly frustrated by the limited mechanismsavailable for promoting social change. Many humanrights monitoring mechanisms, while useful in raisingawareness about human rights abuses, have donelittle to put in place the institutional and culturalbuilding blocks for societies that are inclusive of allgroups. In response to the call for recognition of thehuman rights of people with disabilities developmentagencies, governments and international institutionshave developed models and approaches toredressing exclusion of persons with disabilitiesfocused on the provision of direct support. The disabilityhuman rights agenda has largely been interpretedby policy makers and development agencies as aservice provision agenda; developed as a segregatedsystem of disability specific measures that inadvertentlycontribute to segregation and exclusion. As aresult social exclusion of people with disabilitiesremains the predominate challenge facing advocacyorganizations at the domestic and international level.Much has been made of the new economy emergingas information and knowledge capacities thatare increasingly becoming a driving force of economicvalue. Economic globalization is advancing, butwith it there is a growing polarization between regionsof the world. Societies may be more knowledge-driven,but often it is economic goals drivingknowledge and information development rather thansocial goals. The result is uneven social and economicprogress globally. Many civil society groupshave pointed to the negative impact of contemporaryeconomic globalization on people who are alreadyZeitschrift Behinderung und Dritte Welt 2/200551

SCHWERPUNKTTHEMAvulnerable, and on regions already struggling withlack of infrastructure, poverty, and economic degradation.This is certainly the case for people whohave a disability, for whom the changing structure ofeconomies has the potential to further marginalizeand disadvantage.Given the emerging challenges of a new economy,the limitations of our human rights instruments,and the limitations of current disability relatedinvestments in enabling inclusion, what strategiescan be used globally to advance the humanrights and inclusion of people who have a disabilityin our societies?As one of the seven international disability organizationsrecognized by the United Nations, InclusionInternational (II) has set out a plan to respond to thesechallenges and has developed strategies for making acontribution to the global agenda for poverty reductionand the inclusion of people with disabilities and theirfamilies. The following outlines Inclusion International’sefforts to respond to these issues of social exclusionby drawing from the knowledge of our membershipin over 200 countries around the world and bymobilizing that knowledge to impact on governmentsand donor agencies.Achieving Human Rights MeansAddressing Social, Economic andPolitical ExclusionWhile significant poverty reductionstrategies are being developed by governments,multi-lateral agencies and internationalfinancial institutions, issues ofequity, participation and inclusion areleft to human rights and legal judicialwho have a disability, it is mainstream policies andinvestments in education, poverty reduction, healthcare, strengthening civil society, child protection andothers that have the greatest impact on the inclusion orexclusion of people who have a disability.An Expanding Role for Disability andFamily OrganizationsStrategies Tactics SkillsEducation Meetings, media, workshops,conferences, commissionsResearch, information, analysis,dissemination, communication andarticulationCollaborationPersuasionSome Strategies and Tactics Employed by CSOsBuilding relationships, links,cooperate with governments andother CSOsMeetings, workshops, coalition,lobbying, media, demonstrationCommunication, organization,mobilization, networking technicalcapabilities, transparency opennessand effectivesOrganizing, communication,motivation, negotiation, commitmentand visionLitigation Use of courts Legislation, communicationConfrontation Demonstration, public gatherings, Mobilizing, communication,speechesmotivation, leadershipIn analyzing the slow progress toward inclusion,it is increasingly evident that while significantknowledge exists about how to make inclusion happenin discrete communities, schools or other settingsthis knowledge is not being translated intoresources which can be used in decision makingabout policy development or investments by governmentsand multilateral agencies. What is needed arestrategies to translate what we know about inclusion,how it works in communities and why into structural,economic and social policies that governments,donor agencies and international institutions canadopt and implement as a part of mainstreamsustainable development plans.This means that traditional strategies of advocacyorganizations to act as watch dogs and service deliv-Chart 1: Role of Civil Society Organizations in Governance, Dr. Aishamechanisms for attention. The result is a Ghaus-Pasha, December 2004, United Nationsdisconnect between human rightssystems and the systems that generate and controlwealth. Current initiatives to combat poverty throughinternational financial institutions and governmentsare not effectively, if at all, evaluating the exclusion ofpeople who have a disability from economic and socialparticipation in the construction of policies.Civil society organizations active in internationalcooperation and development have become in manyinstances the delivery agents for these supports supplyinga parallel and substandard social infrastructure.This model of social and economic developmenthas proven unsustainable and ineffective because thereal barriers to inclusion lie in the structure and implementationof social and economic policy. While servicesand supports are important elements in the lives ofpeople who have a disability; and disability specificrights raise awareness of the issues affecting peopleery agents must be expanded to include other rolessuch as knowledge brokers and advocates for policychange. This shift is not unique to the disability sector,the increasing global trend toward democratizationhas opened up the political space for civilsociety organizations to play a more active policyinfluencing role.Traditionally we have used strategies such asawareness raising; litigation and protest to placedemands on the state. We believed that the establishmentof human rights for people with disabilitieswould lead directly to the achievement of thoserights. International cooperation between disabilityorganizations continue to emphasize the need toestablish a framework of rights in developing countriesand countries that are in the processes ofdemocratization. We know now that rights are not52Zeitschrift Behinderung und Dritte Welt 2/2005

SCHWERPUNKTTHEMAenough. We need strategies to help governments anddonor agencies develop inclusive policy approaches.Persuasion/Awareness RaisingThe first challenge we face is in establishing disabilityas an issue that donors, international agenciesand International Financial Institutions (IFIs) recognizewithin their priorities. A recent study done byII of selected donor agencies showed that few hadpolicies on the inclusion of people with disabilitiesin their development priorities and none had successfullyincorporated disability across developmentpriorities.One reason for this has been that the currentemphasis on the United Nations MDGs has left outany reference or consideration of people with disabilities.For this reason II developed a strategy todemonstrate how each of the MDGs is relevant topeople with intellectual disabilities. The II MDGsprovide both targets for the achievement of eachMDG for people with disabilities along with evidenceof the particular vulnerability of people withdisabilities – especially people with intellectual disabilities(see chart 2).To be effective we need evidence that these issuesare substantial and will impact on the achievementof the MDGs. For example in the area of educationit is not sufficient to point out that less than2% of children with disabilities receive an education;rather we must show that 40 million of the120 million children who are out of school have adisability. This means that achieving the MDG onEducation requires strategies to develop inclusiveeducation systems. It puts the issue in the mainstreamdevelopment agenda.Education/Knowledge DevelopmentZeitschrift Behinderung und Dritte Welt 2/2005If we are successful in establishing the importanceof our issues in relation to the larger policyagenda (MDGs) it will likely generate investmentsin research and knowledge development by governmentsand donor agencies. As the World Bank forexample, begins to consider the relationship betweenpoverty and disability, it has begun to invest in datacollection and to encourage governments to determinewhat portion of national populations areimpacted by disability. However the informationproduced by these processes (census data for example)provides only a static and one dimensional pictureof the issues affecting people with disabilities.The knowledge that people who have a disabilityand their families have is of the relationship betweenpeople with disabilities and their families, their communitiesand the social, economic and politicalstructures with which they interact. It is this knowledgethat provides a real understanding of the barriersto participation and inclusion. Civil societyorganizations are a key source for this knowledgeand must be supported to share and contribute thisknowledge with governments and donor agencies.Collaboration/ Policy EngagementEven where there is evidence that the issuesaffecting people with disabilities are important inachieving development objectives and where dataand information is supplemented by real knowledgeabout the issues of exclusion, disability and familybased organizations need to play the role of translatingthese issues into policy. We now know that peoplewith disabilities are at increased risk of HIV/AIDS infection; we understand that this is due totheir vulnerability in society and the lack of accessto public education programming as well as culturalmyths about disability that exist in many countries.What policy issues does this raise for governmentsand for donor agencies? A simple response would beprevention education targeted at this population. Butif these prevention programmes are deliveredthrough schools: are young people with disabilitiesin school, how will deaf people hear public awarenesscampaigns on the radio etc.?Being part of defining the policy issues is criticalif we are to achieve inclusion but grassroots organizationsneed the capacity and skills to know whatto ask for. Much has been made of the fact that peoplewith disabilities and the organizations that representthem have been left out of the PovertyReduction Strategy Paper consultations and the factthat disability where mentioned in PRSPs is seen asa social protection issue. Little has been said aboutthe fact that DPOs in many countries do not have theresources or skills to contribute to this processbeyond the identification of issues. Family basedorganizations may identify needs (services and disabilityaids for example) but few would have thecapacity to introduce tax reform measures to supportfamilies who have a member with a disability or teachertraining and curriculum adaptation strategiesfor inclusive education. Building this capacity requiresinvestment in civil society organizations andknowledge networking strategies. II’s MDGs haveproven to be a valuable communication tool thathelps to raise awareness about the link betweenpoverty and disability but they are also an importantframework for advancing a policy agenda for inclusion.To be effective beyond awareness raising, civilsociety organizations like II must become sources of53

SCHWERPUNKTTHEMAInclusion International MDG’s Data Shows What We Know From PeopleThe World Bank estimates that people withDue to lack of inclusive education, basic services anddisabilities account for as many as one in five ofhealth care, people with disabilities are prevented from1. Eradicate Extreme Poverty the world’s poorest people, suggesting that 260integrating into society. It is very difficult to gainFor People with Disabilities million (43%) of the estimated 1.3 billion peopleemployment with a lack of training and facing employerand their Familiesworld wide living on less than $1 per day have adiscrimination. Without a job or an education peopledisability.with disabilities cannot break the cycle of poverty.2. Achieve Inclusive Education3. Promote Gender Equality forWomen with Disabilities4. Reduce the Mortality ofChildren with DisabilityRecent UNESCO studies suggest the highestincidence and prevalence of disabilities occur inthe poorest areas, where less than 2% of childrenwith disabilities attend school.UNICEF estimates that only around 1% of girlswith disabilities are literate.Mortality for children with disabilities may be highas 80% in countries where under five mortality asa whole has decreased to below 20%.The systematic discrimination and segregation ofchildren with disabilities extends to the classroomwhere teachers have not been properly trained, andinadequate resources are in place to develop inclusiveeducation for all children.Responsibility of care giving falls disproportionately onmothers or female siblings resulting in even feweropportunities for female family members to gainemployment or complete schooling.The lives of infants with disabilities are often soundervalued that they are not cared for or fed asfamilies struggle with meager resources.5. Achieve the Rights ofChildren and Families6. Combat HIV/AIDS7. Ensure EnvironmentalSustainabilityIt is estimated that only 2% of people withdisabilities in developing countries have access torehabilitation and appropriate basic services.The World Bank performed an internationalsurvey which concluded that HIV/AIDS is asignificant and almost wholly unrecognizedproblem among disabled populations worldwide.While all individuals with disability are at risk forHIV infection, subgroups within the disabledpopulation – most notably women with disability,disabled members of ethnic and minoritycommunities, disabled adolescents and disabledindividuals who live in institutions – are atespecially increased risk.UN statistics state that about 20% of alldisabilities are caused by malnutrition and over10% are caused by infectious diseases.Families report that time to build social networks andsupport circles, friendships, get involved in theircommunity are consumed with the need to just get byresulting in fewer mechanisms for support and limitedsocial capitalExtreme poverty and social sanctions against marryinga disabled person mean that they are likely to becomeinvolved in a series of unstable relationships. Disabledwoman are often a target for rape, which puts them atrisk.There are almost no sexual education programstargeted towards people with disabilities. The globalliteracy rate for people with disabilities is estimated tobe only 3%, thus making sexual education andHIV/AIDS information difficult to disseminate,especially for those who are deaf and/or blind.Poor nutrition, dangerous working and living conditions,limited access to vaccination programmes, and tohealth & maternity care, poor hygiene, bad sanitation,inadequate information about the causes ofimpairments, war and conflict, and natural disasters allcause disability.8. Develop a Global Partnershipfor DevelopmentChart 2: Inclusion International’s MDGsRecent estimates indicate that there areapproximately 450 million people with disabilitiesliving in the developing world. Approximately 30-40% of households care for a member with adisability.The exclusion and systemic undervaluing of peoplewith disabilities perpetuates a cycle of poverty andisolation. Unless disabled people are brought into thedevelopment mainstream by creating globalpartnerships for advocacy and development it will beimpossible to achieve full human and economic rights.knowledge. Using the II MDGs as a framework forour agenda II has developed a three part strategy:- Drawing from the knowledge of our members(local families, and people who themselves havea disability) to more fully understand and articulatethe profound costs of exclusion to communitiesand societies;- Strengthening the capacity of member organizationsto meaningfully participate in policy dialogueand governance processes by engagingthem in strategic dialogue about the structuresand processes that impact on their well-being;- Effecting the development of inclusive policiesand practices at the national, regional and internationallevel by contributing our collectiveknowledge about why people are excluded; whatworks; what doesn’t and why.Strategies to advance inclusion must include theestablishment of processes and forums which takeadvantage of the knowledge that exists in communitiesby building on and scaling up from existinglocal, grassroots and civil society developmentactivities, experiences and knowledge. The processesmust link the knowledge of communities topolicy development, implementation and monitoringby governments and international institutions.Shifting from disability policy to inclusive policy is acritical step in realizing the human rights of peoplewho have a disability. In order for societies to valueand respect the contributions of people who have adisability, political, economic and social policiesmust be designed to be inclusive. InclusionInternational, its members and networks can play animportant role in strengthening the capacity of institutionsto adopt inclusive approaches at the global(World Bank, UNESCO, OECD, The G8 etc.);regional (European Union, Organization ofAmerican States, African Union etc.) and national(governments and donor agencies) levels.54Zeitschrift Behinderung und Dritte Welt 2/2005

SCHWERPUNKTTHEMAA Plan of ActionIncreasingly governments and internationalfinancial institutions are recognizing that real knowledgeabout how to address the sources and underlyingcauses of poverty lies with people and communitiesat the local level who live in poverty. The WorldBank’s Voices of the Poor research is based on anunderstanding that the real experts on poverty arepeople who live in poverty. Likewise people whohave a disability and their families are the experts ondisability and the factors affecting their inclusion orexclusion. In order to ensure that people who have adisability are considered in strategies and investmentsto meet the MDG’s, Inclusion Internationalhas designed a global initiative to Link local knowledgeto global change, bringing the voices of peoplewho have a disability and their families who arealso poor to the tables and processes where decisionsare made.Inclusion International is entering the secondyear of a three-year initiative to draw global attentionto the conditions of poverty and their impact onthe lives of people who have a disability and theirfamilies. The initiative will support people with disabilities,their families, associations and networks tocome together in each of the four participating regions(the Americas, Africa and the Indian Ocean,Europe and the Middle East) to develop strategies toidentify the causes of poverty and address those conditions.With the financial support of the NorwegianAssociation for Persons with DevelopmentalDisabilities (NFU), member of InclusionInternational, Inclusion International is workingwith each of its regional associations to host a regionalforum at which the initial research findings willbe used as a basis for developing strategies andimplications for policy in different sectors.The initiative will use the process leading up toand following each of the regional conferences tobuild a base of knowledge about poverty and disability.Over the three years of the project II will developa baseline global report on poverty and disabilityusing the II MDGs as a framework to be releasedat II’s World Congress in Mexico in 2006.To date reports from the Americas and Africahave been completed and strategies for advancingagendas of poverty reduction in those regions havebegun to take shape.Drawing from the voices of people who have adisability and their families, Voices from theAmericas (www.inclusion-international.org) providesan analysis of the implications of each of theMillennium Development Goals for people with disabilitiesand their families: “Listening to familiesZeitschrift Behinderung und Dritte Welt 2/2005helps us to understand that poverty does not affectonly individuals but poverty is systemic human issueaffecting families, communities and nations.” (Dr.Roberto Leal, Executive Director Inclusion Inter-Americana). By examining the experiences of peoplewho have a disability in the Americas, the reportdemonstrates that the way in which a person’s disabilityis experienced is significantly impacted byconditions of poverty (personal and community).The findings of this report reflect the need for a shiftin the focus of development assistance from addressingdisability as unique programming issue to beginto integrate disability issues into government, donoragency and NGO strategies across sectors at thenational, regional and global level. It also points tothe need for approaches to poverty that acknowledgepoverty as an issue of exclusion.The Interim Report on Poverty and Disability inAfrica identifies structural reform issues such asgood governance and the need for effective processesfor civil society participation in policy developmentalong with sectoral issues such as the increasedvulnerability if people with disabilities to HIV/AIDSand the need for inclusive education reform.Parallel processes for collecting knowledge and analysisfrom families and individuals are underway inEurope (with a particular focus on Eastern Europe) andin the Middle East North Africa for 2005.Making a Difference in People’s LivesUltimately, the effectiveness of InclusionInternational’s strategies can only be measured bywhether we are making a difference in the lives ofpeople who have an intellectual disability and theirfamilies. Yet measuring progress in this regard is difficult.As an international organization our job is notto deliver projects that help ten, twenty or a hundredindividuals at a time, this is the job of our memberorganizations. Rather II’s job is to support our membersin their efforts and to scale up that work internationallyso as to create change at a systemic level.Making sure that the voices of people with intellectualdisabilities are heard and respected in the negotiationof a new UN Convention on Disability; playinga leadership role in having the people with disabilitiesincluded in the Millennium DevelopmentGoals; providing our members with a platform fromwhich they can take advantage of opportunities suchas the Commission for Africa’s work. There is someevidence that governments and international agenciesare taking seriously the call to include peoplewho have an intellectual disability in their programmingand investments. Some results to date that aredirectly or indirectly linked to our efforts include:55

SCHWERPUNKTTHEMA- In Honduras, the national Federation embarkedupon an intense lobbying effort and managed tohave the state include persons with disabilities asa sector into its national programme againstpoverty and extreme poverty;- In Panama, the First Lady will convene a regionalmeeting of first ladies on poverty and disabilitydrawing from Inclusion International’s report;- In Nicaragua, the Ministry of Health with our memberorganization has a pilot programme to distributefolic acid, covering 16,000 women residing in fourof the areas most affected by poverty;- In Africa, a network of family organizationsacross west and south Africa have agreed tocollaborate on poverty and disability research;- The Commission For Africa included childrenwith disabilities in their recommendations oneducation in Africa.Inclusion International has committed itself to addressingthe systemic issues of social, economic and politicalexclusion faced by people who have an intellectualdisability and their families. To achieve theseobjectives we will need to have an impact on developmentagencies, international financial institutions andgovernments. Our job is to strengthen the capacity ofthese institutions to develop inclusive strategies fordevelopment. It is no longer enough to say we want tobe included, now we must show them how.Zusammenfassung: Trotz internationaler Unterstützungvon Initiativen zu Gunsten von behinderten Menschen inEntwicklungsländern hat sich deren wirtschaftlicher, politischerund sozialer Status bislang kaum bis gar nicht verbessert.Um zu verstehen, warum Menschen mit Behinderungnoch immer zu den am meisten benachteiligtenBevölkerungsgruppen auf der Welt gehören, müssen wireinen Blick darauf werfen, wie sie von politischen Entscheidungsträgernwahrgenommen werden und wie Entwicklungspolitikmit dem Thema Behinderung umgeht.Wenn ein wirklicher Fortschritt im Hinblick auf dieLebensverhältnisse behinderter Menschen erzielt werdensoll, müssen sich sowohl die Wahrnehmung von Menschenmit Behinderungen als auch unsere politischen Zieleändern. Die Autorin unterstreicht die Notwendigkeit einesWandels von einer Behindertenpolitik zu einer inklusivenEntwicklungspolitik und stellt fest, dass zivilgesellschaftlicheOrganisationen erweiterte Strategien benötigen, umzu diesem Wandel beizutragen. Die globale Strategie, dieInclusion International entwickelt hat, um die Einbeziehungvon Menschen mit geistigen Beeinträchtigungen undihren Familien in die Millennium Development Goals derVereinten Nationen voranzutreiben, zeigt, was dieserWandel für eine internationale Behindertenorganisationbedeutet, und verdeutlicht, wie aus lokalen Initiativen einglobaler Wandel entstehen kann.Résumé: En dépit d'investissements internationaux pourdévelopper les initiatives visant les personnes handicapées,les investissements par les gouvernements locauxsupportant les personnes handicapées et les implicationspar les gouvernements vis-à-vis des engagements internationauxet locaux des droits de l'homme, pratiquement peua été accompli pour améliorer la condition économique,politique ou sociale des personnes qui souffrent d'uneinfirmité dans les pays en voie de développement. Pourcomprendre pourquoi les personnes handicapées continuentà être parmi les plus désavantagées au monde, il fautque nous considérions comment ces handicapés sontperçus par les faiseurs de politique et comment la politiquede développement aborde l'infirmité. Si un réel progrèsdoit être réalisé en améliorant la qualité de vie despersonnes handicapées, la perception des handicapés etnos buts politiques doivent tous les deux changer. L'étudesouligne la nécessité pour un changement de la politiquepour handicapés à une politique globale de développementet propose que les organisations de société civileréclament des stratégies élargies pour contribuer à cechangement. La stratégie globale engendrée par InclusionInternational afin de promouvoir l'inclusion des personneshandicapées intellectuellement et de leurs famillesdans le Millennium Development Goals des NationsUnies, illustre ce que ce changement signifie pour uneorganisation internationale d'handicapés et démontrecomment nous pouvons relier les voix locales au changementglobal.Resumen: La autora subraya la necesidad del cambio dela política de la discapacidad a la política del desarrolloinclusivo, y constata que las organizaciones de la sociedadcivil requieren estratégias mas amplias para fortalecereste cambio. Inclusion International desarrolló unaestratégia global para integrar Personas conDiscapacidad Mental y sus familias en las MillenniumDevelopment Goals de las Naciones Unidas. La estratégiaenseña el significado que tiene este cambio para unaorganización internacional en el área de la discapacidad,y muestra además como un cambio global puede surgir deiniciativas locales.Autor: Connie Laurin-Bowie ist Projekt Direktorin fürInclusion International. Sie hat mehr als 15 JahreErfahrung in den Bereichen öffentliche Politik undKommunikation mit Regierung. Connie hat einenHonest degree in Politikologie der Universität WestOntario und einen Master in öffentlicher Verwaltungder Queen’s Universität. Vor ihrer Arbeit für InclusionInternational hat sie für 10 Jahre für die CanadianAssociation of Community Living gearbeitet.Anschrift: conniel@cacl.ca56Zeitschrift Behinderung und Dritte Welt 2/2005

SCHWERPUNKTTHEMAPerspectives on Disability, Poverty and TechnologyDavid Seddon, Bill Albert, Rob McBrideThe Knowledge and Research (KAR) Programme of British Department for International Development (DFID) has linked disabilitywith healthcare technology and for this reason DFID has been interested in the potential role that technology plays – andcan play – in reducing (or possibly in increasing) disability. It is axiomatic that technology plays an important role inaffecting the physical environment and the immediate physical circumstances in which disabled people live and work. Itcan produce built environments that constrain or offer facilities to disabled people, it can produce equipment andmachinery, which also has the potential to provide opportunities or create restrictions for disabled people. Technologyis rarely disability-neutral. It is often argued that improvements in specific disability related technology can play a major rolein improving the lives of disabled people. These improvements do not always imply more advanced technology, but oftentechnology that is 3A – appropriate, accessible, and amenable – to the needs of disabled people across the world. Formost poor and disabled people, however, appropriate technology is not accessible and what technology is available is notamenable to their needs. This paper is concerned with the relationship between disability, poverty and technology in thedeveloping world.A conceptual approachIt is suggested, firstly, that the concepts of disability,poverty and technology are all best understoodin terms of dynamic social processes and this papersets out an approach to disability, poverty, technologyand development based on the social model ofdisability. It argues that disability is both differentfrom and more comprehensive than impairment, anddefines disability as the consequence of variousforms of social discrimination and exclusion forpeople with impairments. For this reason, nationaland international statistics on the prevalence or incidenceof physical and/or mental impairment are inadequateas a guide to the prevalence and incidenceof disability. Furthermore, such data offer a partialand often misleading notion of social reality of disabilityin developing countries. It cannot, therefore,be used to gauge the specific needs of disabled peopleor as a basis for estimating the costs and benefitsof any particular programme. This paper argues theneed to formulate an integrated strategy towards disabilityand development. It recognises the value ofprogrammes like the Knowledge and Research(KAR) programme supported by DFID and recommendsthe funding of such initiatives in applied oraction-research to examine further the relationshipin different contexts of disability, poverty and technology.Disability, poverty and technologyAlthough poverty and disability are often conceivedas static and specific states of being – a sortof negative endowment – and technology as infrastructureor equipment, they are all better understoodDieser Artikel wurde ursprünglich im Asia Pacific Disabilityrehabilitation Journal in Ausgabe 1 2004 veröffentlicht.as the manifest and specific outcomes of dynamicsocial processes. Disability is not the same asimpairment, and the problems and methods of dealingwith impairment prevention and with disabilityare, therefore, often, although not always, significantlydifferent. Disabled people have increasinglychallenged the view that disability should be equatedwith impairment (the medical model of disability),arguing that what disables people are the varioussocial and physical barriers and negative attitudes,which prevent equal participation in community life.Within this social model, disability is seen as theresult of social exclusion and discrimination – as adependent variable.The social model offers a powerful frameworkfor understanding the complex issues of disability,poverty and technology. It reveals disability as acrosscutting social issue, and the primary policyfocus then becomes changing the conditions and circumstancesin which disabled people are constrainedor prevented from full participation as equal citizens– that is, reducing social exclusion. DFID’s statementon Disability, Poverty and Development tends to confusethe two approaches (medical and social), but leanstowards the medical model, seeing disability as “longterm impairment, leading to social and economic disadvantages,denial of rights and limited opportunities…”thereby equating impairment and disabilityand characterising them as independent variables.Poverty used also to be characterised very muchas a state of being requiring intervention and rehabilitation;increasingly, however, it is being definedas the consequence of social discrimination andsocial exclusion. Poverty in this sense needs to beunderstood as an outcome of social processes, whichproduce and reproduce it – oppression, subordination,exploitation and discrimination. Poverty is notonly a dependent variable, and the consequence ofsocial processes, it also is the root cause of manyforms of impairment. But being poor is, even moreZeitschrift Behinderung und Dritte Welt 2/200557

SCHWERPUNKTTHEMAsignificantly, a major factor in transforming impairmentinto disability. Poverty may generate impairment,through malnutrition, disease and inability togain access to adequate health services; it also excludesthose with impairments from many normaleveryday activities and thereby increases disability.Disability exacerbates poverty, while having impairmentmakes being poor more gruelling and inexorable.Poverty, disability and impairment are clearlylinked in a deadly mutual embrace.Technology is best seen as the process of theapplication of knowledge to find effective solutionsto social problems. Technology and its outcomes(which may include buildings, transport systems,assistive equipment, etc.) can dramatically affect theenvironment within which people live and work andmay itself significantly increase or decrease the barrierswhich prevent disabled people from participatingfully in social life. Technology can be immenselyliberating and empowering for disabled people ifdeveloped within a framework which prioritisestheir real needs as well as their genuine participationat all levels. The provision of appropriate technologicalsolutions in a manner which empowers theusers, should not be seen as outside or opposed to asocial-model approach, but as a critically importantelement in this approach. For example, for millionsof poor disabled people, the lack of low-cost, appropriatemobility aids and assistive equipment is amajor barrier to social integration.The social model in practiceThe social model has been the foundation for thedisability movement, because it offers a true representationof disabled people’s experience and hasproved a powerful lever for antidiscrimination legislationand other policy changes. It provides a proteanchallenge to the disablist paradigm so often associatedwith the medical model. The needs of disabledpeople (like disabled people themselves) have all toooften been equated with special – outside the normal– and disability has all too often been equated withabnormality and with illness.There is a tendency for those concerned about disabilityto speak and act on behalf of disabled people.Charities and NGOs tend to be run by members ofsocial and political elite groups, who may capture ordivert programmes and projects. The need for disabledpeople and their organisations to be actively involvedin defining their own needs and designing their ownsolutions is central for the social model approach.Self-reliance does not necessarily mean standingalone; it does mean being in control of what kind ofsupport is wanted and required, by whom or what,58and when. This implies a demandled support systemin which disabled people, together with specialistsand others serving as facilitators can begin to worktogether to make judgements about what mightprove to be appropriate and sustainable technologieswith respect to disability in specific social contexts.The extent of disability in developingcountriesVery little is known in detail about the nature,extent and severity of disability in developing countries;not much more is known about the prevalenceand incidence of impairment. Social discriminationbased on gender is widespread; so too is discriminationbased on other sociocultural definitions of identity– caste and ethnicity in particular – and on socioeconomicstatus, or class. These forms of discriminationaffect the nature and severity of disability amongpeople with impairments, according to their gender,caste or ethnic group, social class – or indeed age. Butrelatively little is known in detail about how preciselydisability and social discrimination relate to otherforms of social division – it may be that poor, lowcaste women are more severely disabled than wealthy,high caste men with the same physical or mentalimpairment, but this is not necessarily the case.The nature of impairment is also poorly understood.Usually taken as a given, even in the socialmodel of disability, impairment – like disability – isin fact socially defined and constructed. What isregarded as an impairment in one social context,may not be in another. The registered prevalence oflearning difficulties, for example, is rapidly rising ashitherto socially unrecognised conditions (e.g., dyslexia)are diagnosed, or as new conditions arise (asin the case of HIV/AIDS, which now falls within theremit of disability legislation in several countries).Global statistics on impairment (often confusedwith disability) – because definitions vary, investigationsare incomplete and people with impairmentsare often not recorded or identified as such – areunreliable and based on guesstimates. The figure of600 million people or 10 per cent of the total populationis often cited – but this too is a guess. Acrosscountries, estimates vary from as high as 12-15 percent (in some developed countries) to as low as 1-2per cent (in many developing countries). This suggeststhat data are unreliable and misleading.Furthermore, although some of the reasons for thisare, as indicated above, the result of deficiencies indefinition or counting, there may be other, moreimportant reasons which remain unclear. The apparentlylow incidence of impairment in many developingcountries may simply indicate that mortalityZeitschrift Behinderung und Dritte Welt 2/2005

SCHWERPUNKTTHEMArates are very high among poor people with impairments,and they disappear from the recorded population.It may also indicate generally lower rates ofrecognition (where physical or mental impairment ismore common, the threshold for its definition asserious may be higher). All too little is known.The new International Classification ofFunctioning, Disability and Health (ICF) attempts tomeasure impairment and disability from a perspectivethat is somewhat closer to the social model (althoughit still emphasises the capacities and capabilitiesof the individual rather than the barriers andconstraints of his or her social and physical environment)and was adopted by the WHO in May 2001. Itwill take some time, in any case, to implement.Attempts have been made to address the problem ina more systematic objective fashion. The WHO hascompiled figures on Disability Adjusted Life Years(DALYs) by region, to reveal some significant differencesin the impact of impairment (and disability)on life expectancy and life expectations, but themeasurement itself is based on essentially arbitrary,negative assumptions about the quality of disabledpeople’s lives.The available global and regional data indicatethat malnutrition, resulting from material poverty, isone of the most common causes of impairment andthat many kinds of impairment are the result of specificdiseases or conditions for which there existrelatively straightforward and inexpensive preventivemeasures. Poverty and poor access to simpleremedies are thus key factors in the prevalence andincidence of impairment.The identification and classification of impairmentin a population is not the same as the analysisof the nature, extent and severity of disability in asociety. Both are of major importance, but it is thelatter that is crucial for the reduction of disability,but is even more difficult to identify and deal with.Such a task is best undertaken at the national, subnationaland local level where there is a greateropportunity for the specifics of disability andimpairment to be recognised and understood and theappropriate forms of intervention (whether involvingtechnology or not) devised.The value of interventionsZeitschrift Behinderung und Dritte Welt 2/2005The use of conventional benefit-cost analysis,with its emphasis on direct economic value within aspecified (usually limited) time-frame is not reallyappropriate, as usually applied, in assessing thebenefits of interventions designed to address disabilityissues. Nonetheless, broad social costeffectivenessmust be a consideration in the selection of policies,programmes and projects. If interventions(technological or other) are both appropriate andsustainable then they will tend to be costeffective inthe sense that they are likely to be widely adopted byrelatively large numbers of disabled people and usedover a relatively long period of time.Ideally, the more disabled people are involved indebates on assessment and evaluation, in their localor national context, the more any debate about costsand benefits can be grounded in the social and politicalrealities. This has already been recognised aseffective in various forms of participatory evaluation,whether it is participatory action-research orparticipatory learning and action, of so-called povertyalleviation policies, programmes and projects.There is a growing recognition that it is effective aswell as appropriate to involve people at all stages inthe formulation, design, implementation, monitoringand evaluation of policies, programmes and projects.Effective, interactive participatory techniques forneeds assessment, project appraisal, implementation,monitoring and evaluation, which include and involvedisabled people must become part of the repertoireof all those working in the development field,particularly at the local level. A review of experiencewith disability projects and examination of specificcase studies suggests that all projects should be firmlyrooted in the expressed needs and demands of disabledpeople in a specific local social and physical context.In most developing countries, the national level isinvolved where government and international (bilateraland multilateral) agencies are most likely todevelop policies, programmes and even projectswith respect to disability reduction. But it may be atthe sub-national (regional, district and local community)level that such higher-level agencies will needto work together systematically with local NGOs,organisations of disabled people, researchers andothers with relevant skills and expertise, to developappropriate projects, programmes, policies andlegislation to reduce disability.Disability and development: towards a globalstrategyDespite the undoubtedly vast number – hundredsof millions at least – of poor disabled people in thedeveloping world, disability as an issue does notfigure in either of the British Government’s WhitePapers on International Development, and is barelymentioned in any of the key documents of the internationaldevelopment agencies over the last decade.There has been growing interest in, and concernabout, disability – notably in specific agencies. TheWorld Bank, for example, and USAID; JICA and the59

SCHWERPUNKTTHEMAAsian Development Bank; NORAD and the otherScandinavian government aid agencies, and some ofthe international NGOs (like Save the Children)have turned their attention increasingly towards disabilityissues. Some have even begun to talk aboutpolicy to mainstream disability, just as gender hasbeen mainstreamed in recent years. Mainstreamingdisability in a major development agency means thatall policies, programmes and projects should includedisability as a key issue, and that monitoring andevaluation should track both the involvement andempowerment of disabled people in the design andimplementation of policies, programmes and projectsand the impact of these policies, programmesand projects on disability reduction.The authors believe that development agenciesshould increasingly integrate disability within themainstream of their development policy and practiceby adopting a social-model approach and by identifyingdisability as a major crosscutting issue. Thiswould imply, in effect, adopting a twin-track strategy– already advocated by DFID in its paper onDisability, Poverty and Development – and adoptedwith respect to gender issues. Several other developmentagencies have already moved quite a way inthis direction. In order to implement such a strategyand policy for disability and development, it isessential that all development agency staff recognisethe links between reducing disability and other developmentpriorities, such as alleviating poverty. Butfor this to happen, they have to see disability as acrosscutting development issue. One important wayin which this can be facilitated is to introduce appropriate,social-model based disability equality training.Just as gender-blindness has been identifiedeven at the highest levels in international developmentagencies and NGOs, so too the risk is strongthat disability blindness may affect these agencies,unless strong preventive measures are taken.There is a growing interest in, and concern for,disability issues in development among the majorinternational agencies. Several international NGOsand some organisations specifically concerned withdisability and development have already charted thebroad direction in which theoretical and practicalwork should be moving. Greater effort needs to beput into disseminating new information and bestpractice with regard to disability and developmentbetween institutions and agencies. Publications suchas Asia Pacific Disability Rehabilitation Journalproduced by Action for Disability should be able toplay a significant role by publishing ideas, experienceand case material, examples of best practiceand of innovations which can feed into what needs tobe a fuller and more comprehensive international60discussion and dissemination process. At the sametime, those working in the field of disability anddevelopment should be aiming to write for publicationsin development studies so as to reach a widerand different audience, of development policymakers,practitioners and professionals. On the otherhand, those with experience and expertise in disabilityand rehabilitation should be equipping themselveswith an appreciation and understanding of thelatest thinking in development, bringing developmentand disability studies and practice closer together.Proposals for the development of DFID’sdisability strategyIn 2001, DFID produced a paper on Disability,Poverty and Development in which an attempt wasmade, for the first time, to focus on disability as asignificant development issue linked to poverty, andto develop a framework for addressing disability as apolicy issue. The establishment and continuation ofDFID’s Knowledge and Research (KAR) Disabilityand Healthcare Technology Programme is anothersign that DFID is beginning to address disability asan issue for action-research as well as for policy andpractice. But while the establishment of the KARProgramme and the production of the strategy papermentioned above indicate an emerging awarenesswithin the agency of the need to address disabilitywithin the context of development policy and practice,there is as yet little evidence of an integratedand coherent approach to the issue. Disabilityremains institutionally as well as conceptually andpractically marginalised, with responsibilities withinDFID itself fragmented.Recent re-structuring of DFID has meant that acertain amount of impetus has been lost as olddepartments and divisions have been replaced bynew teams and focal areas. It is not at all clear whereresponsibility for disability issues and developmentsit in the new DFID that is now beginning to emergefrom its re-organisation. Perhaps it is a good time todefine a new strategy. Such a strategy should bedeveloped in collaboration with other like-mindedinternational agencies seeking to integrate disabilitywork with development priorities, whether these areessentially disability – or development – focused,and with the existing international organisations ofdisabled people.The authors suggest that DFID establish a crosssectoral,crossthematic Disability and Developmenttask force or team with a clear mandate to mainstreamdisability and to focus more attention on it asa specific development issue. In the new KARProgramme for 2006 there is a specific project toZeitschrift Behinderung und Dritte Welt 2/2005

SCHWERPUNKTTHEMAassist DFID in developing such a focus on disabilityand development. In terms of defining strategy forDFID, one possibility would be to commission theredrafting of the short paper on Disability, Povertyand Development, to provide a more substantial andsubstantive document on which to base policy andpractice throughout the organisation. Another wouldbe to produce more focused papers showing howdisability would be integrated into the work of specificteams and focus groups.The need for research on disability anddevelopmentZeitschrift Behinderung und Dritte Welt 2/2005One urgent priority is to increase knowledgeabout existing approaches to disability and development,both in theory and in practice, and to identifybest practice as regards disability and development,both in government agencies and in non-governmentorganisations. This should be undertaken through aninitial review of research and publications on disabilityand development, which could complement existingreviews of CBR and related programmes.At the same time, a register or compilation ofstatements and policies on disability and developmentby international, bilateral and non-governmentagencies and organisations would be valuable, aswould an international register of organisations andinstitutions with a proven capacity to design andimplement innovative disability projects (includingresearch institutions, NGOs, DPOs and private sectorenterprises). Healthlink Worldwide under the previousKAR Disability and Healthcare TechnologyProgramme has made a start on this. Thirdly, in thecontext of a stated concern with respect to technologyfor disability reduction, an international networkof technology providers for disability reductionneeds to be compiled.The authors also argue that it would be useful toundertake a comprehensive study, which wouldinvolve a review of literature (and other sources)relating to disability and development, a review andanalysis of significant programme or project initiatives(involving research and/ or implementation),and a listing and discussion of country-by-countryexperience with respect to disability and development.This would constitute a fairly substantial project,but could be undertaken on a collaborative basis.There are several areas in which new researchshould be carried out. The issue of disability andolder people is becoming a matter of major concernin many developing countries as the demographicstructure changes. Projects related to this issue,would be a priority. There is evidence to suggest thatin developing countries many children with impairmentsdie young or are ignored. We need to knowmuch more about such children and their early lives.Finally, the relationship between disability andpoverty requires more systematic investigation on acomparative basis across countries.ConclusionThis paper emphasises the need to recognise theimportance of disability as a development issue, as asocial issue, and as an issue closely linked to the statedpriorities of the major international and bilateraldevelopment agencies and NGOs.Technology generates outcomes and productswhich could be liberating and empowering for disabledpeople, but, like both disability and poverty, itneeds to be seen as essentially a social process,capable of generating negative as well as positiveoutcomes as far as disabled people are concerned.More research is needed to identify examples ofbest practice as regards developing appropriate technologyfor disabled people. Access to technologies,which reduce barriers to inclusion and participation(not only assistive or specifically healthcare technologies)should be seen as a basic human right.Disability should be mainstreamed in the policies,programmes, projects and daily practice of developmentagencies and consideration given to the developmentof appropriate technologies as one component ofa strategy for disability and development.Development agencies, like DFID, need to recognisethe importance of disability at all levels, anddevelop an appropriate institutional response, includingthe introduction of disability equality trainingand a greater degree of decentralisation in terms ofpolicy and practice, given the importance of the specificsocial context of disability.Each country development strategy should includea section on disability and development, as anintegral part of their overall vision for the developmentof the country concerned; and country levelstaff should also receive disability equality training.DFID and other development agencies shouldpromote a twin-track approach to disability, as hasbeen done with gender. All development initiativesor projects should be able to demonstrate that theyare truly inclusive of disabled people. Significantadditional funds should be made available to supportdisability-specific initiatives.AcknowledgementThis paper is based on a Report produced by ateam of specialists engaged by the OverseasDevelopment Group at the University of East61

SCHWERPUNKTTHEMAAnglia, in response to terms of reference drawn upby Healthlink Worldwide and GIC Ltd., based on aconcept note produced by the British Department forInternational Development (DFID). Other contributorsincluded Ken Cole, Roger Cozens, VictoriaDaines, Ray Lang and Indumathi Rao.Zusammenfassung: Das Knowledge and Research (KAR)Programme des britischen Department for InternationalDevelopment (DFID) beschäftigt sich mit der Rolle, dieTechnologie beim Abbau (möglicherweise auch beimAnstieg) von Behinderung spielt – und spielen kann. Es istdavon auszugehen, dass Technologie für Menschen mitBehinderung eine hohe Bedeutung hat, da sie die physischeUmgebung und die unmittelbaren physischenUmstände beeinflusst, in denen behinderte Menschenleben und arbeiten. Durch die Herstellung von Gerätenund Maschinen kann sie eine Umgebung schaffen, dieMenschen mit Behinderung einschränkt, oder die ihnenMöglichkeiten bietet. Technologie ist selten behinderungsneutral.Häufig wird argumentiert, dass Verbesserungenin bestimmten behinderungsrelevanten Technologien einewichtige Rolle bei der Verbesserung der Lebensumständevon behinderten Menschen spielen können. DieseVerbesserungen bedeuten nicht immer eine fortschrittlichereTechnologie, sondern eine, die angepasst an dieBedürfnisse behinderter Menschen auf der ganzen Weltist. Die meisten armen und behinderten Menschen habenjedoch keinen Zugang zu angepasster Technologie, unddie verfügbare Technologie ist nicht angepasst an ihreBedürfnisse. Der Artikel untersucht die Beziehung zwischenBehinderung, Armut und Technologie inEntwicklungsländern.Resumen: Este artículo examina la relación entre discapacidad,pobreza y tecnología en los países en vías dedesarrollo. El programa Conocimiento e Investigación(KAR) del Departamento para el DesarrolloInternacional (DFID) de Gran Bretaña trabaja sobre estetema. En pocos casos, la tecnología es neutral para ladiscapacidad, élla siempre influye al medio ambiente físicode la persona y la producción de medios técnicospuede disminuir o aumentar las posibilidades para laparticipación de la Persona Discapacitada. Lo importanteen todo el mundo no es la tecnología más avanzada omoderna, sino la tecnología apropiada a las necesidadesde la Persona con Discapacidad. Lamentablemente, lagran mayoría de los pobres y discapacitados no tienenacceso a esta tecnología, pues la tecnología accesible noes apropiada.Autor: David Seddon ist Professor am Institute forDevelopment Studies der University of East Anglia inNorwich/Großbritannien.Anschrift: School of Development Studies, Universityof East Anglia, Norwich NR4 7TJ, Großbritannien, E-Mail: j.d.seddon@uea.ac.ukRésumé: Le programme Knowledge and Research (KAR)du Department International Development (DFID) britanniques'intéresse au rôle potentiel joué par la technologie- ou peux jouer en réduisant (ou éventuellement enaugmentant) l'infirmité : On peux présumer que la technologiepour handicapés joue un rôle de première importanceen influençant l'environnement physique et les circonstancesphysiques immédiates dans lesquelles les personneshandicapées vivent et travaillent. Grâce à la fabricationd'appareils et de machines elle peut créer un environnementconstructif qui limite ou qui leur offre des possibilités.La technologie est rarement neutre à l'infirmité.On prétend fréquemment que des améliorations dans certainestechnologies appliquées à l'infirmité peuvent jouerun rôle important en améliorant la qualité de vie des personneshandicapées. Ces améliorations ne sont pas toujourssynonymes d'une technologie de pointe, mais d'unequi est adaptée aux besoins des personnes handicapéesdans le monde entier. La plupart des personnes pauvres ethandicapées n'ont cependant pas accès à une technologieadaptée et la technologie disponible n'est pas adaptée àleurs besoins. L'article étudie le rapport entre infirmité,pauvreté et technologie dans les pays en voie de développement.62Zeitschrift Behinderung und Dritte Welt 2/2005

SCHWERPUNKTTHEMAApplying the Minority Perspective to Disability in AfghanistanMajid TurmusaniAs a minority group, disabled people throughout the world continue to be excluded from mainstream society and this isoften exaggerated for those belonging to ethnic minority groups. This paper argues that this exclusion is also pertinentin the context of Afghanistan, especially where ethnic conflict applies. Although the ethnic relations and their dynamicshave changed and notably improved since the fall of Taliban in late 2001, disabled Afghans who belong to these groupscontinue to be severely excluded from various spheres of social, economic and political life. Generally speaking, thereare three groups of disabled people in Afghanistan which experience higher levels of discrimination and exclusion thanothers. These groups at risk include: children with disabilities, disabled women, and elderly disabled people, to be furtherdiscussed below. The new National Constitution guarantees the rights of all citizens including those with disabilitiesand so does the recently completed Comprehensive National Disability Policy. However, both of these instrumentslack the necessary mechanisms and strategies for their proper implementation concerning disability issues. Therefore, acollective and coordinated action is needed for better highlighting and integrating the concerns of disabled people, especiallythose at risk groups on the public agenda. This may include researching, disseminating and further debatingvarious issues of disability and ethnic relations both nationally and internationally – with the lead given to disabledAfghans in this process.Ethnic backgroundHistorically and until recently, many societieshave been designed to meet the needs of themajority population. The needs of minority groupsincluding those with disabilities as a result have beenexcluded or poorly addressed. This institutionalexclusion is not only in terms of services, but canalso be seen in policy and program planning. This isespecially true for disabled people who belong tominority ethnic groups (Asch 2001).In Afghanistan, racial and ethnic difference is anissue which has contributed to the escalation of conflictin the country and widened the difference betweenvarious sections of society. There are at least 6major ethnic groups in the country with a majoritybeing Pushton. These groups have their own language,and culture. This makes differences obviouseven under the same religion of Islam – there arevariations of Islam such as Sunni and Shiite andrecent years had seen conflict between them. This isparticularly the case between the largely Pushtonfollowers of Sunni Islam and the mainly HazaraShiite. While the geographic variation between ruraland urban living contribute to this difference, languageand religion remain two determinants ofgroup identity in Afghanistan.Difference, naturally, generates an opportunityfor learning and for growth. In a democratic environmentwhere the human rights of all people arerespected, difference always is a healthy sign forpotential development. For some individuals andgroups however, difference may generate fear andfear may generate more difference unfortunately.Unless these differences are resolved in a healthyDieser Artikel wurde ursprünglich im Online Journal vonwww.disabilityworld.org im Februar 2005 veröffentlicht.Zeitschrift Behinderung und Dritte Welt 2/2005manner – through communication – they willescalate and cause rifts and gaps between groupssuch as in Afghanistan. Difference however, is notonly confined to expressed values and beliefs butalso manifest in the way people look, physical materialistappearance and physical status, and whichgroup people belong to, etc. The core issue of differenceis the exclusion of those perceived as differentfrom the norm.Disability and exclusionThe difference of disability is often perceived asa ground for exclusion from society, especially theeconomy, and this is also evident in Afghan society.Oliver and Barnes (1998) argue that much of theexclusion of disabled people has been supported byinstitutional practices. The fact that disability wasconsidered a charity issue, few provisions weremade for disabled people. Available provisionstherefore did not give disabled people the rights toaccessing education, employment etc., but insteadwere left to the good will of society to provide disabilityservices voluntarily and not according to the law.There are certain sectors which experience ahigher level of exclusion among disabled people,intensifying or multiplying the level of exclusionbased on ethnic minority origin. This is evident inAfghanistan and includes people with severeintellectual – mental and psychiatric – or multipledisabilities, elderly people, rural disabled, those displacedby violence, the war disabled and disabledrefugees. Children with disabilities have traditionallybeen seen as less worthy of social investment –access to education for example – than other children.Women with disabilities often suffer doublediscrimination. Minority groups, including racial63

SCHWERPUNKTTHEMAand ethnic minorities, are similarly disadvantaged.The invisibility of disabled Afghans means exclusionfrom all spheres of socioeconomic and culturallife as well as exclusion from the democratic processin its various levels. A lack of participation in thepolitical process can result in policy being formedwithout the active involvement of groups likely to beaffected by its outcome. It can also lead to passivityand dependence which serve to perpetuate the invisibilityof disabled people. Invisibility often means thatthe universal right of equal opportunity is simply notapplied equally to disabled people, contrary to what isoutlined as recommended by the UN Standard Rulesand the current UN draft disability convention.While disabled people have been largely excludedfrom the mainstream in Afghanistan, progresshas been made in understanding disability issues andproviding specialized services including CBR programsmainly for physically disabled people.Notably, there has been greater advocacy for disabledpeoples’ rights and gradual development ofskilled professionals working in this sector. Forexample, the recently completed ComprehensiveNational Disability Policy has been developed inclose collaboration with the disabled community.There are three groups of disabled people inAfghanistan which experience higher levels ofdiscrimination and exclusion than others: childrenwith disabilities, disabled women, and elderly disabledpeople, to be further discussed below.Children with DisabilitiesThere are no reliable national data available onthe incidence of disability among children or amongthe population in general in Afghanistan. However,the U.S. Centre for Disease Control (CDC) andUNICEF conducted a disability survey in 2003 andthey found that 1% of Afghan children are disabled(CDC/UNICEF 2003). It is believed however thatthere are more children with disabilities than 1% inAfghanistan. Landmines alone have disabled thousandsof children who often fetch water, collectwood, tend the flocks, or play in the fields unawareof the danger buried under their feet. The weak preventativehealth services have led to a high incidenceof disabling conditions such as polio andtuberculosis. The high level of birth complicationsand under-nourishment amongst girls and women,and inadequate medical care, also gives rise toimpairments such as cerebral palsy in newborns.According to WHO, the infant mortality rate is 165per 1000 live births (WHO 2002). Malnutrition,poverty, and road accidents contribute to a higherrate of disability among children.64Exclusion of disabled children from services isevident in Afghanistan regardless of their ethnicminority backgrounds. For example, The CivicVoluntary Group (GVC), an Italian NGO, conducteda study on disabled children in education in the cityof Kabul in 2003 and found that only 1.11% of totalstudents were with disabilities. In rural areas whereethnic groups are more evident due to the tribal natureof Afghan society, exclusion of disabled childrenis clear due to total absent of services in suchplaces. Until recently, exclusion of girls from educationwas a common practice, but this is slowly changing.However, the lack of female professionals continuesto exclude many girls from receiving servicesdue to cultural restriction on female/male relations.This is especially true for rehabilitation and medicalservices where women’s bodies may only rarely beexamined or treated by male professionals. TheInternational Convention on the Elimination of AllForms of Racial Discrimination recognizes that racialdiscrimination can itself cause disability. Forexample, racial groups may be restricted or deniedaccess to services and this may escalate impairmentsinto disability. Given the gravity of the situation ofdisadvantaged minority groups in Afghanistan such asHazarah for example, there are a number of NGO’swho focus their work on serving these groups.Nowadays, there are little opportunities for childrento play and practice normal childhood lifeactivities. There is a rather dangerous phenomenonin Afghanistan concerning street children. In bigcities, especially in the capital Kabul, there are hundredsof kids who took to the street as home and as aplace for earning a living, mainly from begging –many of these children are disabled. The fact thatwar has left many children without fathers or withoutfamily altogether, meant that these children haveto survive on the street especially in the absence ofan effective education and welfare support system.Moreover, the war has brought the risk of displacementof countless number of families and individuals.Many families of disabled children have movedto urban centers in search of security and job opportunitiesespecially after the ban of poppy (illegaldrugs) production in their rural areas or when losingthe breadwinner. While, urban living helped manychildren get an education, it exposes them to otherforms of city dangers such as road accidents andincreased pollution, homelessness and gang habits,and street children life.The majority of Afghan children lost members oftheir family in the war and all of them had beenthrough the war and the resulting aftermath. It isbelieved that children have been traumatized by thewar, especially if this involves the loss of familyZeitschrift Behinderung und Dritte Welt 2/2005

SCHWERPUNKTTHEMAmembers. While this is the situation, there are stillnearly no psychological and counseling services forthese children at all. It is believed by both the internationalcommunity and the government that the traditionalfamily unit has mechanisms to cope withsuch mental health problems. However, this has notbeen properly debated, researched or documented.Based on the above analysis, growing up as a disabledchild in Afghanistan is a challenging processthat is full of dangers and exploitations as citedabove. Although Afghanistan has ratified the CRC,there are no special laws to promote and protect therights of disabled children which are prescribed byArticle 23 of the international Convention on theRights of the Child (CRC) unfortunately.Disabled womenAlthough the situation of women in Afghanistanis improving, there is still much to be done regardingwomen’s rights and the status of women in society.The traditional gender role that confines women tothe role of housewives and deprives them of educationand employment is still common, especially inrural areas. The lack of sufficient female rehab workershas also affected the use of rehab services by girlsand women as indicated earlier. Female early marriage,the lack of mother and child health care and thehigh fertility rate for women are all factors that workagainst the progress of women in Afghanistan.When women are disabled they are more vulnerableto marginalisation and exclusion. Disabledwomen are often deprived of education altogether aswell as other life opportunities including work, participationin political debate and denied the right toestablish their own families. There is lack of awarenessregarding women with disabilities and reproductivehealth needs – more often disabled womenare regarded as sexless (Nagata 2003).To raise the profile of women in the country, theTransitional Government of Afghanistan has establisheda separate ministry for women issues.Despite this ministry, gender and women issues havenot been mainstreamed into other government programsuntil now. Moreover, disability issues amongwomen have not been taken into account in the programsof this ministry either. There is an obviouslack of a gender and disability strategy for this ministryas well as throughout the country.As far as we can ascertain, there are no studies onthe situation of disabled women in Afghanistan. Theworking group on disabled women which was set upfor drafting recommendations for the national disabilitypolicy has debated the issues of disabledwomen in terms of needs and priorities. The needs ofZeitschrift Behinderung und Dritte Welt 2/2005disabled women have been identified to include:education including higher education, health andmedical care, participation in all spheres of lifeincluding public events with media coverage, involvementin policy making process and employmentof disabled women in all key ministries. Thesewere guided by the international framework ofCEDAW, the Biwako Millennium Framework (BMF)and the new draft disability convention.This working group comprised representatives ofall stakeholders working with women including disabledwomen themselves. They recommended anumber of strategies for meeting the above needsincluding mainstreaming disability and gender, settingup an office responsible for the employment andadvocacy of disabled women’s rights, setting upmodern training programs as well as reviving oldtechniques of home based training, promoting accessibilitystandards including accessible housingsystem, policy monitoring should be carried out withparticipation of disabled women, and supporting disabledwomen against violence including psychologicalsupport and counseling services. The latter isinteresting to note as both the government and theinternational community regularly question thevalue of psychological services. Yet, we find disabledwomen calling for psychological supportamong their priorities for independent living.Elderly disabled peopleThere are indicators showing the aging populationin Afghanistan and the urgency for special programsto cater for their needs. The fact that manymen were killed in the war meant that widows wereleft to age and die naturally. Moreover, as the warended, it is expected that the mortality rate for bothwomen and men will rise above the low life expectancyof 45 years (UNICEF 2003). This means morepeople will live to old age and experience old ageimpairments such as hearing and vision problems aswell as other mobility problems. Indeed, aging anddisability will develop a closer association.Traditionally, disability services reached primarilythose disabled by war, usually young or adultmales. Although, these war disabled persons havegrown up now, until this moment, disability programshave not considered services for the elderlypopulation apart from limited orthopedic services.This is especially true for older women who requireinterventions different from the population of youngerwomen who need an emphasis on maternity care.Recently, however, disability programs have paidattention to children’s issues as a priority in terms ofeducation and physical rehabilitation. Overall, the65

SCHWERPUNKTTHEMAelderly disabled population remains very under-researchedand underserved, deserving the attention ofplanners, service providers and policy makers.Cross cutting issuesTrauma and psychological support: The longyears of war resulted in not only an increased deathtoll, but also bereaved, stressed, and traumatizedsociety who requires much psychological support.The Taliban practices of punishments in publicincluding amputation and stoning, has also beenanother source of trauma and distress, especiallyamong children and women. Psychosomatic illnessis quite common among women due to stress anddepression. The social and economic capacity ofmany families has been significantly reduced due tothe loss of breadwinners or other family members.State welfare support to families of martyrs and disabledpeople are nearly nonexistent. Many familiesare being left with war or landmine disabled memberswho need rehabilitation services includingcounseling. The mental health situation of women,children, and refugees, are particularly poor withinthis war-torn country. Although there is a substantialproportion of drug users and dealers who also havemental health problems, there is hardly any servicefor this group either.The low profile of mental health issues inAfghanistan is mainly due to negative public perceptionand stigma of those who are mentally ill. Thereis stigma towards mental illness, often perceived asbeing punishment of sin. Many families conceal thepresence of mentally ill members to protect thefamily reputation and marriage prospects for othersiblings. Mentally ill people are therefore often keptaway from sight and remain an invisible groupamong the already excluded disabled population.They are as a result prevented from education, vocationaltraining and other community services.The national health plan adopted by the Ministryof Health had no specific reference to the problemsof people with mental health impairments. TheInterim Health Strategy 2002-2003 and the BasicPackage for Health Services for Afghanistan 2003have both identified mental health issues as a challengefor post conflict development of health sectorin the country. However, neither identified mentalhealth issues as a priority and, therefore, no plans forspecific programs were proposed. It is therefore,perhaps, no surprise to find a lack of mental health facilitiesand mental health professionals in the country.Accessibility: An effective inclusion strategy forthe largely excluded disabled people in Afghanistanrequires comprehensive rehabilitation program66including psychological support system. This will bepossible only within a barrier-free environment thatkeeps universal design ideals in mind. It is notenough to make buildings accessible if there is noaccessible transport system to get people to such places.Equally, it is important for disabled people to haveaccessible housing where they can live independently.Accessible environment can be useful not only to disabledpeople but to everybody including elderly population,pregnant women, children, and other groups.Central to accessibility standards is an informationand communication system that covers all typesof disability, gender, geographic areas, and all agegroups. This system may include training programsand provision of specialist devices when necessary.Self help groups: Disabled people know bestabout their priorities and their organizations have astrategic advantage to advocate their rights andinfluence public decisions concerning their issues(Kasnitz 2001). Currently there are a number ofinformal self-help groups of disabled people inAfghanistan including one group for disabledwomen – the National Association of DisabledWomen in Afghanistan (NADWA). These groups areindependent from the government and have thepotential to foster disability movement in the future.However, training, awareness raising, financial support,and collaboration with other stakeholders,especially the government, is all necessary for thedevelopment of this sector. DPI Asia and Pacifichave conducted leadership training for these groupsin Afghanistan last year and communication continuesbetween DPI and some of these groups.There is an obvious need for grass roots action tosupport the future disability movement inAfghanistan. The working group on self-help groupsfor planning the national disability policy has identifiedthe needs of disabled people to include differentself help groups according to types of disability,financial support for such groups, friendly and cooperativegovernment relations, and supporting thedevelopment of self-help groups into recognizedorganizations including umbrella organizations.ConclusionThe fact that disabled Afghans were a hiddengroup meant that society knew very little about theirsituation: their needs and aspiration, and moreimportantly about their abilities and their rights. Itcan be argued that empowering minority disabledgroups, therefore, necessitate not only giving powerto disabled people over their lives, but also makingknowledge about disability available to the publicincluding policy makers and the disabled communi-Zeitschrift Behinderung und Dritte Welt 2/2005

SCHWERPUNKTTHEMAty themselves, hence making disability a visibleissue. This will create opportunity for debate overdisability issues and present a chance for change.The participation of disabled people and their organizationin this debate is fundamental and goes inline with the Afghan Comprehensive NationalDisability Policy 2003 as well as in line with UNStandard Rules, BMF and the recently drafted disabilityconvention.Despite the fact that the recently endorsedNational Constitution of Afghanistan made all citizensequal before the law in terms of their rights andresponsibilities, disabled people continue to bedeprived of services on many grounds and this isoften justified by lack of resources. Until now nationalplans took little notice to integrate disability concernsinto their respective programs. TheComprehensive National Disability Policy hasemphasized the value of coordinated and collaborativeeffort between all stakeholders in dealing withdisability issues including those pertaining to minorityinvisible groups.LiteraturAFGHAN CONSTITUTION: Draft NationalConstitution of Afghanistan. 2003. URL:http://www.constitution-afg.com/draft_const.htmBMF: Biwako Millennium Framework for ActionTowards an Inclusive, Barrier Free and Rights BasedSociety for Persons with Disabilities in Asia and thePacific (BMF). United Nations Economic and SocialCouncil, Otsu City, Shiga, Japan, 2003CEDAW: The Convention on the Elimination of all Formsof Discrimination against Women. 1979CIVIC VOLUNTARY GROUP: The Situation ofDisabled Children in the Education System inAfghanistan: a study for the city of Kabul. Kabul 2003CRC: The United Nations Convention on the Right of theChild. 1989ICERD: The International Convention on the Eliminationof All Forms of Racial Discrimination. 1965KASNITZ, D.: Life Event Histories and the USIndependent Living Movement, in: M. Priestley (Ed.),Disability and Life Course: Global Perspectives,Cambridge University Press, Cambridge 2001, pp. 67-78MINISTRY OF PUBLIC HEALTH: Interim health strategy2002-2003. 2003MINISTRY OF PUBLIC HEALTH: A basic package ofhealth services for Afghanistan. 2003MMD: The Comprehensive National Disability Policy.2003. URL: http://www.disabilityafghanistan.org/NAGATA, K.: Gender and Disability in the Arab Region:the challenges in the New Millennium. Asia PacificDisability Rehabilitation Journal, Vol 14, No 1, 2003Zeitschrift Behinderung und Dritte Welt 2/2005OLIVER, M./ BARNES, C.: Disabled People and SocialPolicy: From Exclusion to Inclusion. London 1998UNICEF: The State of the Worlds Children. 2003WHO: Afghanistan Health Sector Profile 2002: a contributionto the debate on health sector recovery. Geneva2002Zusammenfassung: Als Minderheit werden Menschenmit Behinderung auf der ganzen Welt immer noch ausgeschlossenvon der Mehrheitsgesellschaft. Dies gilt umsomehr für solche, die einer ethnischen Minderheit angehören.Der Artikel zeigt, dass dies auch für den KontextAfghanistans zutrifft, besonders dort, wo ethnische Konfliktevorherrschen. Obwohl sich die Beziehungen zwischenden Volksgruppen seit dem Fall des Taliban-Regimes2001 deutlich verbessert haben, werden behinderteAfghanen, die diesen Gruppen angehören, immer nochvon allen Bereichen des sozialen, wirtschaftlichen undpolitischen Lebens ausgeschlossen. Es gibt drei Gruppenvon behinderten Menschen, die ein höheres Maß anDiskriminierung und Ausgrenzung erfahren als andere.Diese Gruppen sind: Kinder, Frauen und alte Menschen.Die neue Verfassung wie auch die nationale Behindertenpolitikgarantieren allen Bürgern die gleichen Rechte –auch denen mit einer Behinderung. Jedoch fehlen beidenInstrumenten die nötigen Mechanismen und Strategien zuihrer Umsetzung. Daher ist eine koordinierte und konzertierteAktion notwendig, um die Belange behinderterMenschen ins Rampenlicht zu stellen, besonders diejenigender Risikogruppen. Dies schließt die Erforschung,Verbreitung und Diskussion von Behindertenthemen undethnischen Beziehungen auf nationaler und internationalerEbene ein – wobei die Leitung dieses Prozesses denbehinderten Afghanen obliegen sollte.Résumé: En tant que groupe minoritaire les personneshandicapées du monde entier continuent à être exclues dela société majoritaire. Ceci est d'autant plus valable pourceux qui appartiennent à une minorité ethnique. L'articlesouligne que cette exclusion est également exacte dans lecontexte de l'Afghanistan, spécialement où il y a les conflitsethniques. Bien que les relations entre les ethnies sesoient considérablement améliorées depuis la chute durégime taliban en 2001, les Afghans handicapés faisantpartie de ces groupes, continuent à être exclus de tous lessecteurs de la vie sociale, économique et politique. Il existetrois groupes de personnes handicapées qui dans unegrande mesure expérimentent plus que d'autres la discriminationet l'exclusion. Ces groupes sont les enfants, lesfemmes et les personnes âgées. La nouvelle constitutionainsi que la politique nationale des handicapés garantissentà tous les citoyens les mêmes droits - également pourceux souffrant d'une infirmité. Cependant, à chacun deces deux instruments font défaut les mécanismes et lesstratégies nécessaires pour leur réalisation.Il est donc nécessaire qu'il y ait une action coordonnés etconcertée pour mettre en avant les intérêts des personneshandicapées, surtout pour ceux des groupes à risque.Cela englobe la recherche, l'élargissement, les débats sur67

SCHWERPUNKTTHEMAles sujets concernant l'infirmité. Est aussi englobé sont lesrapports ethniques au niveau national et international oùla conduite de ce procès devant incombée aux handicapésafghans.Resumen: Este artículo tematiza la discriminación queconviven las Personas Discapacitadas como miembros deuna minoría étnica en Afganistán. Aunque se ha mejoradala situación después de la caída del régimen de losTaliban en al año 2001, las Personas con Discapacidadde estos grupos estan todavía marginadas en todas lasáreas de la vida social, económica y política. Entre elloshay tres grupos donde la discriminación es mas alta:niños, mujeres y personas de mayor edad. Lo masnecesario son actividades coordinadas y concertadas deconcientización, incluyendo investigaciones y discusionessobre las temas de la discapacidad y relaciones étnicas.Autor: Dr. Majid Turmusani, Politikwissenschaftler,forscht zu Themen aus dem Bereich Behinderung undEntwicklung. Er hat über zahlreiche internationaleBehindertenprojekte in Jordanien, Jemen, im Kosovo,in Afghanistan, Großbritannien und Kanada gearbeitet.Zu seinen letzten Publikationen gehört ein Buch überMenschen mit Behinderung und ÖkonomischeBedürfnisse in Entwicklungsländern (Disabled Peopleand Economic Needs in the Developing World: politicalperspective from Jordan). Im vergangenen Jahr warer als Afghanistan-Berichterstatter für www.disabilityworld.orgtätig. Turmusani hat zahlreiche Artikel zuThemen der internationalen Politik verfasst, unteranderem zur UN-Konvention für die Rechte vonMenschen mit Behinderungen.Anschrift: Turmusani@hotmail.comChallenging International Development’s Response to DisabilityTamsin BradleyThis article argues that developing countries are often portrayed as being backward in appreciating the importance ofinclusion. In addition the stigma attached to disability is thought to be greater in the Developing World. This article acknowledgesthe implications scarce resources have on inclusivity but argues that this does not necessarily reflect deeperprejudice in regard to disability. The development discourse has constructed a category of underdeveloped Other which isused to depict all marginalised people. This label fails to acknowledge and appreciate the different experiences and needsof people living with impairments. This article then goes on to highlight the support networks that are indigenous tomany societies and suggests that development interventions should build on these rather than transplant a westernmodel of inclusion. The article will develop these arguments through a case study documenting the life experiences ofa rural poor, low caste Indian family of four. The wife and two daughters are blind. The sighted husband is the primarycarer and cannot work because of the level of support required by his wife and two daughters. In the absence of a statewelfare system this family is supported by families within the community who belong to the same social caste. The UKNGO working in the area uses images of this family to highlight extreme suffering and discrimination; it does not seekto appreciate how they cope with everyday life. The argument stressed throughout this article states that outside agenciesmust be motivated by a desire to know and understand the experiences of those living with impairments if theirinterventions are to be effective.IntroductionThis article argues that the voices of disabled peoplehave been systematically excluded frominternational development agendas because a homogenousimage of an underdeveloped Other continuesto influence development practice and policy. Whendepicted the disabled body is presented as an exampleof extreme and desperate human suffering.Whilst the link between poverty and disability isaffirmed by this article the oppressive impact ofusing broad labels and images to describe the experiencesof others is critiqued. If the complexities ofexclusion and social marginalisation experienced bydisabled people in the Developing World are to befully appreciated and responded to then the voices ofpeople living with impairments must be listened to.This article supports a right-based social modelof disability. This defines disability as the loss orlimitation of opportunities to take part in everydaylife of the community on an equal level with othersdue to physical and social barriers. The term impairmentis used as defined by Barnes (1991) as a functionallimitation within the individual caused byphysical, mental or sensory impairment. My viewexpressed throughout this article (and shared bymany) is that impairment need not lead to exclusionand inequality if inclusive policies are implemented.This article argues that at present this view is not shapingdevelopment policy on disability. The relativelyfew interventions directed at disabled people stressthe need for medical solutions rather than societal.A common critique directed at developmentinterventions claims that insufficient attention isgiven to understanding local knowledge and littleattempt is made to understand the life experiences ofthose aid is targeted towards (Chambers 1996,Pottier 1993, Gardener and Lewis 1996, Hobart68Zeitschrift Behinderung und Dritte Welt 2/2005

SCHWERPUNKTTHEMAZeitschrift Behinderung und Dritte Welt 2/20051993, Mosse 2005). Furthermore an assumption ismade that the West has got it right. Western modelsof social inclusion enshrined in legislation are propoundedas the way forward in the quest for greatersocial equality for disabled people. This articlebegins by critiquing the work of development agencieson disability through an analysis of theapproach taken by many agencies. Focus will beplaced on how these goals translate into developmentpractice. The primary argument states that suchapproaches fail to acknowledge the agency of disabledpeople and do not seek to acquire deeperknowledge and insight into the experiences of disabledpeople across the Developing World. Thisarticle emphasises the importance of dialogue betweenagents of change (disabled people) and agentsof development (NGOs). This dialogue involves adisruption of the usual power relation between recipientand givers of aid. In a development relationshipit is usual for the recipient to be in the weaker orsubordinate position. The giver (of aid) holds powerover the Other (recipient of aid) and can bypass theexperiences of others in deciding what is best forthem. This process marginalises disabled people furtherand fails to acknowledge and respect the agencyof each individual person whose desires and needsmay be very different from others.The starting point for any intervention must bethe acknowledgment that disabled people as individualshave voices. As individuals they should belistened to as they articulate their experiences ofmarginalisation. Development interventions must bedesigned through a dialogue between all parties andmust be open and constant. This dialogue must buildupon existing support networks rather than implantwestern constructed models of ideal social inclusion.Policy and practice must influence each otherin a constant and ongoing manner (Mosse 2005).This process should be mediated by the experiencesof those it is intended to help.This article uses ethnographic research techniquesin presenting a case study of one family’sexperiences of living with impairments. The casestudy focuses on a family of four, three of whom arevisually impaired. The family are from a low casteand live in rural Rajasthan. I visited this family inJanuary 2002 with a Gandhian NGO and theirwestern donor agency. The experience of visitingthis family provoked many feelings and reactions inme which I feel should also be documented in thisarticle. These experiences have allowed me to thinkabout disability and international development witha certain openness and reflexivity which should bean integral part of the development process. I am anoutsider and in my attempt to understand the experiencesof others I must be open in exposing my ownprejudices and the impact of my western culture onmy perceptions of social exclusion in ruralRajasthan. I spent six months living in the same areaof Rajasthan as this family. I visited them on a fewoccasions and learnt of their progress through thelocal Gandhian NGO. It was clear that although thereare limits in terms of life opportunities open to thismother and her young daughters they are supportedby a caring community who firmly believe they havea right to a secure subsistence. As with all ethnographythe account of this family represents a story, mystory which I very much hope is also theirs.Critique of Development Practice in Regardto DisabilityThe image of a physically disabled person livingin extreme poverty is often used by NGOs. The useof such an image assumes that to be disabled in theDeveloping World means you are acutely poor. Thislink between disability and poverty then conjures upmany more assumptions of extreme hopelessnessand desperation. In using this image the notion ofdisability and poverty as the worse case of humansuffering is asserted. Beresford (1996) points outthat an analysis of disability based solely on povertyis both inaccurate and misleading. Clearly disabledpeople are presented as specimens of truly oppressedvictims of backward societies in need of salvation. 1Although it is true that disabled people are among thepoorest in the Developing World (Kauppinen 1995) theconstant use of extreme images of impairment andpoverty homogenises disabled people into a singlecategory of underdeveloped. The result of this homogenisationis highly oppressive. Berresford states: “Therehas been a tendency to isolate and lump people togetherindiscriminately as poor, without examining the differentcauses of their social and economic exclusion, andto stereotype them as dangerous or dependent. Theeffect has been to obscure both people’s differences andtheir shared oppressions.” (1996:554-5)The labels of poor and disabled are highly stigmatisingand an unhelpful basis for action. To bepoor and disabled is not just about a low standard ofmaterial comfort and subsistence but is also about adenial of rights. In addition such labels fail to allowindividual disabled people to articulate their differentexperiences of both poverty and living withimpairment. These experiences are often excludedand systematically ignored by development policy.Instead a larger image of an underdeveloped Other isused by the international community towards whichpolicy and aid is directed. This over arching imageof an underdeveloped person cannot respond to the69

SCHWERPUNKTTHEMAhuge variants of marginalisation and is the reasondisability has been consistently ignored by internationaldevelopment agendas.The term underdeveloped 2 is used to denote thosewhom the West sees as in need of enlightenment(Esteva 1993). According to Hobart (1996), developmentpractice is in reality a strategy for the maintenanceof western sovereignty through transformingthe underdeveloped in order for them to fit into avision that reflects the way the dominant powers(West) would like the world to be (Sachs 1992,Escobar 1988, Chambers 1996). Gramsci (1971)anticipates this argument when he describes howmodernisation theory sees society or culture as theobstacle and the element that must be changed ifhegemonic values are to be imposed and westernpower assert its control. Through this process oftransformation the underdeveloped Other is encouragedto strive for the status of a developed person:“the knowledges of the peoples being developed areignored or treated as mere obstacles to rational progress.”(Hobart 1993:2) In fact, the individuals whoare supposed to be the recipients of improved livesare rendered passive. Agency is identified only withchanges in the economic or political structures of acountry, and western knowledge, through the processof development, consequently embeds itself inthe political culture of underdeveloped countries.Those that are placed in the category of underdevelopedare considered ignorant and in need of thecontinued presence of western NGOs. If a projectfails development practitioners will often blame thelack of appropriate knowledge of the local community(Mamdani 1972). Local knowledge is therebyimpoverished by the development discourse(Richards 1993). Those targeted to receive aid arenot involved in the decisionmaking (Black 1991);instead western constructions of knowledge determinewho is qualified to know and act and who isnot. The discourse creates the development expert(typically white, middle/upper-class and educated), theonly one who possesses the wisdom to effect positiveand lasting change (Parpart 1999). This expert designsthe development policies which through their microfocus hide a macro level political agenda which isdetached from the daily realities of the poor.An Other has been created to symbolically representthe supposed needs of the Developing World, butbecause this Other has been constructed by the developmentdiscourse it blocks access to real people andreal needs. The huge budgets that development agenciescommand contrasted with the limited success theirinterventions achieve clearly suggests that something isgoing wrong. De Sousa Santos (1999) states: “Suffice itto recall how the great promises of modernity remain70unfulfilled or how their fulfilment has turned out tohave perverse effects.” (1999:30) De Sousa Santos listsstatistics that reveal an ever-widening gap between therich and the poor. Further evidence to support the claimthat development is failing to deliver on its promise ofglobal equality can be found in the numerous analysesof failed development projects (Gardener and Lewis1996, Crewe and Harrison 2000, Marchand and Parpart1999, Mosse 1994, Hobart 1993). A main reason for aproject’s lack of success is often identified by the authorsof case studies as being inadequate consultationwith members of the target community. NGOs’ actionssuggest that they believe that consultation betweenNGO workers and the recipients of aid is not neededbecause NGOs believe they already know the focus oftheir compassion. However, if they really knew whattheir recipients needed than surely the success ratewould be higher? The effects of NGOs will continue tobe limiting for as long as they are focused on this symbolicOther rather than the lived realities of others.Hobart (1993), Escobar (1988), Esteva (1993:90),Mosely (1987:21), Hayter (1971) and Sobhan (1989)all describe how the overarching discourse of developmentfunctions to prevent reality from emergingthrough its repressive homogenisation of whole populationsinto this image of a poverty stricken Subject (orOther).Yeo and Moore (2003) and Masset and White(2004) state that disability has been systematicallyignored by development agencies, this is clear by thefact that it rarely appears as a separate issue on internationaldevelopment agendas. Until this overarchingnotion of an underdeveloped Other is eradicatedthere exists little chance of a space opening upfor meaningful dialogue based on a respect for individualrights. Such a space requires, not just anappreciation of difference, but a consensus over therights that have been so far denied to disabled people.Attitude change alone cannot achieve inclusionof disability in the development discourse. A dramaticshift must occur that depassifies the disabledbody by acknowledging the voices of people livingwith impairments. The current impulse dominatingthe development industry in which the diversity ofvoices are ignored must be replaced with a desire toknow and understand the needs of others.At present the development discourse believesthat there is only one path for human progression,which involves the transformation from underdevelopedto developed. In relation to disability this processutilises medical intervention to rectify the perceiveddamage of the disabled body (Coleridge1993). Although disabled people living in theDeveloping World do need money, this money mustbe channelled through a dialogue that wishes to hearZeitschrift Behinderung und Dritte Welt 2/2005

SCHWERPUNKTTHEMAand respond to their specific experiences of marginalisation.In other words, if the social model of disabilityis to work effectively in the Developing Worldit most be founded on a shift in how disabled peopleare viewed by development agencies.The biggest barrier to the implementation of arights-based social model of disability is that at presentpower is exercised through money, and thosewho want donor aid must conform to the dominantrationality of the giving institution (Hulme andEdwards 1997). According to Hulme and Edwards(1997) and Edwards and Hulme (1992) NGO workersinsist on certain conditionalities (which haveoften been set by larger donor agencies) that determinethe specific nature of the projects implemented.These conditions remove the possibility of dialoguethrough which projects can be constructed inpartnership with local communities. Individualswithin target communities are therefore treated aspassive subjects and are denied the agency to shapetheir own futures. This imposed subjectivity contradictsthe stated objectives of development practice asit serves to limit human freedom rather than increaseit. Escobar (2002) and Sachs (1992) go as far as todescribe this process as violent. This oppression ishidden within development because of the objectiveof alleviating suffering. It is not the stated desire torid the Developing World of poverty that is the problembut rather the way in which this suffering issymbolised within the boundary of a subject projectedas the underdeveloped Other. This symbol actsas a camouflage, and as long as this suffering subjectexists it requires a second subject who presents itselfas possessing the potential to liberate. However, ratherthan liberate, the second subject dominates anddictates how the Other should live. Until this relationshipof dominance at the heart of the aid industryis challenged the experiences of disabled people willcontinue to be ignored. Furthermore the increasedlevels of poverty and global inequality will continue.A shift in power must therefore occur that allows forboth parties in the aid relationship to be regardedequally. In such a relationship Fagan (1999) arguesthat local people should be perceived as agents ofdevelopment rather than as passive recipients. Thegiver of aid merely facilitates and supports the actionsand desires of the person living with impairment.Deconstructing the Passive SubjectThe answer to overcoming this hegemony is notthe withdrawal of western assistance from theDeveloping World. It is not acceptable for NGOsjust to disappear from the lives of others for fear ofbeing accused of dominating and suppressing themZeitschrift Behinderung und Dritte Welt 2/2005(as Hobart 1993, Bloch 1983, Hayter 1971, Escobar1995 and Sobhan 1989 seem to suggest). Di Leonardrejects such an outcome, arguing that “post-moderncultural relativism falls into politicised irresponsibility.”(1991:24) Theory falling in the category of“post development” (Parfitt 2002) can certainly beaccused of this. Fagan similarly argues: “adoptingthe privilege of being antidevelopment is not in myview politically or morally viable when sitting in an‘overdeveloped’ social and individual location.”(1999: 180) Instead the challenge to the macro levelpower structure must come from the grass roots; thelived experiences and agency of those this symbolicorder wishes to maintain as passive subjects. Imagesof disabled people living in acute poverty must bereplaced by a plurality of voices talking about theirlife experiences and dreams.Listening and responding to othersThe relationship between others or specifically betweenNGO workers and agents of development mustbe founded in respect between others and a desire tounderstand their differences. The work of LuceIrigaray is useful in understanding the qualities thatmust be present in a relationship that is free frompower. Irigaray (2000) states that the space betweensubjects must be transformed from one in whichpower is contested to one shaped by peace and tranquillity.In such a space listening to the other does notinvolve the destruction of the other. Irigaray claimsthat an equal and harmonious relationship with another is worth striving for since it offers the possible ofreciprocity from which both parties can benefit. Shestates that it is through a relationship with an other thatyou should come to know yourself. There is a reflexivedimension in the dialogue with the other. “As I knowyou I let you see what I know of you; in return youallow me insight into what you know of me.” (Irigaray2000:32) This dialogue relies upon the determinationof each party to know the other and in doing so facilitatethe other in their own personal development.Irigaray describes a relationship based on a perfectlyreciprocal dialogue in which both beingsreflect what they have learnt of each other. Silence isa vital component in this discourse; without it reflectionis not possible. Without silence the voice of theother cannot be heard. According to Irigaray, if suchrelationships comprised society, then the arms of thestate would operate to preserve and respect individualityrather than to master it and acquire supremacy.If such a dialogue founded development practicethen the present tendency in development practice todominant the Developing World through replicatingwestern values and models would cease.71

SCHWERPUNKTTHEMANGO workers must acknowledge their positioningwithin the binary opposition Developed/Underdeveloped and move towards a reciprocal relationshipas outlined above. However, if reciprocity isto be achieved then the NGO worker has to allowher/himself the possibility to change as a result ofinteracting with agents of development. If change isacknowledged as a benefit of such a relationship thepower imbalance caused by the presence of donormoney can be reduced. Although the agent of developmentwill not give money back to the NGO workerthey can at least give them the chance to seethemselves in a new way. If aid were to be conceivedof in terms of a reciprocal gift which all partiesbenefit from the power embedded in the term aidcould be replaced with a sense of equality. Stirratand Henkel (1997) state that as it currently stands,there is nothing reciprocal about the act of giving indevelopment. “Here, the act of receiving is hedgedwith conditionality at best, while at worst the giftmay become a form of patronage and a means ofcontrol.” (1997:72) Aid is a vehicle through whichthe giver can attain dominance over an Other. Theconcept of gift could be reciprocal if the giver could letgo of the desire to transform the Other and realise thepotential for their own growth through dialogue withothers. To be open to what the other can give you drivenby a concern to express love and respect holdspowerful potential to restructure the relationship betweenNGO workers and agents of development.The case study presented below represents myattempt to gain an understanding of how others liveand experience their specific impairments. My informantshave raised provocative questions that challengedassumptions that the Developing World possessesthe most backward and prejudicial of attitudestowards disabled people. Whilst Yeo and Moore’s(2003) article can leave us in no doubt that disabledpeople in the Developing World are marginalised bysocietal factors these case studies suggest that moreethnographic research is needed documenting howdifferent communities respond and react to livingwith people who have impairments.Case Study: Blind family in RajasthanNorth IndiaNeela is a blind forty-three year old mother oftwo daughters. Both daughters – Prem who is twenty,and Shobila who is twenty-four – are also blind.The father’s name is Krishnam, he is fifty-five and isthe only sighted member of the family. This familyis from a low caste known as Kumhar which translatesas potters. It is traditional for Kumhar familiesto make their living making and selling clay pots.72These pots are used to fetch and carry, and storewater. Krishnam is unable to work because he mustremain at home to look after his wife and daughters.Because this family is so poor they do not haveaccess to technology and life is hard. Cooking isdone over a fire which requires wood to be collected.The process of collecting, laying and lighting a fire iscomplex and virtually impossible without sight. Theprocess of collecting and carrying water from the villagewell is also complicated when you have no sight.Neela, Prem and Shobila cannot go out unguided.I first visited this family in January 2001, it was afleeting trip and I was with a group of representativesfrom a UK donor agency. It was a strange anduncomfortable experience. We visited this family inthe pitch black. The family’s home has no lightmostly because of the cost of electricity. Suddenlyflashes started going off from cameras. I caughtglimpses of Neela, Prem and Shobila, in the splitseconds as the flashes went, obviously they couldnot see me. Others in my group were keen to capturethis family on camera, keen to expose, revealwhat could not be seen in the darkest of the night. Ilater saw the photos of that night and felt uneasy.The camera had been pointed straight at their eyes.The eyes captured in this shot clearly belonged tosomeone who had a severe visual impairment. Thepictures were then used on a display board to promotethe work of the NGO. This family was used asan example of disadvantage and extreme povertymuch in need of western help. Whilst Krishnam,Neela, Prem and Shobila did need help, what wasnot told in that picture or elsewhere was the extent towhich they were being supported. I asked them onanother visit how they coped with everyday life.Krishnam described how family friends came eachday with food and helped with household chores.In Krishnam’s own family it was only his youngerbrother and his wife who came to help. Krishnam’sfamily was poor and not seen as a good match. Neela’sfamily were keen to marry her to someone who wouldlook after her. The only family willing to take her wasKrishnam’s. The financial drain Neela was thought tobring was too great for other more wealthy families. Thedifficulties Neela found in getting married highlightsher social exclusion. Harris-White (1999) documentsthe difficulties disabled people in Tamil Nadu face ingetting married and argues these experiences point to anunequal access to rights of passage. Despite this level ofexclusion Neela and her daughters have been supportedby families belonging to the same caste. This supportwas maintained throughout long spells of heavydrought. This sense of responsibility towards themexpressed by their community is perhapslinked to notions of caste identity. Both Zene (2004) andZeitschrift Behinderung und Dritte Welt 2/2005

SCHWERPUNKTTHEMALeslie (2004) explore notions of collective caste identity,which they argue unites families and individualsregardless of levels of poverty, gender and disability.The experiences Neela and her daughters have ofliving with an impairment were not appreciated bythe donor NGO. The photographer ceased a photoopportunity. The image provided him with evidenceof extreme poverty and suffering. This NGO did notattempt to access the specific needs of this familybut used their image to further create a category ofan underdeveloped Other. If effective strategies toease the marginalisation of this family are to beimplemented they must be founded on an understandingof what support already exists and appreciationof what kind of life Neela and her daughters wouldlike to lead. This information can only be gatheredthrough open and empathetic dialogue.ConclusionAlthough a rights-based approach is needed interms of addressing the lack of resources given todisabled people in many developing societies themechanism through which these rights are to be deliveredalso needs to be examined more closely. Atpresent the aid industry has not adopted a methodologythat is reflexive enough to allow for the experiencesand voices of others to be heard. Until a moreeffective model is formulated and adopted it is unlikelya social model of disability will ever be successfullyimplemented in the Developing World.Anmerkungen1 De Groot makes a similar argument in relation towomen. She describes how women in this discourseare understood to be “exotic specimens, asoppressed victims, as sex objects or as the mostignorant and backward members of ‘backward’societies.” (1991:115) Women are portrayed as aweak Other contrasted against the strong liberatedwomen of the West.2 Bloch and Bloch (1980:127) discuss the binaryopposition inherent in the development discourse,which separates the North (civilised) from theSouth (uncivilised).3 “The advanced capitalist countries, amounting to21 per cent of the world’s population, control 78per cent of the world production of goods andservices and consume 75 per cent of all the energyproduced. Textile or electronics workers in theThird World earn twenty times less than workersin Europe and North America doing the samejobs with the same productivity. Since the debtcrisis emerged in the early eighties, Third Worldcountries in debt have been contributing to theZeitschrift Behinderung und Dritte Welt 2/2005wealth of developed countries in liquid terms, bypaying each year an average of $30 billion morethan what they get in new loans. During the sameperiod, available food in Third World countriesdecreased by about 30 per cent.” (de SousaSantos 1999:30)LiteraturBARNES: Disabled People in Britain and discrimination: Acase for anti-discrimination legislation. London 1991BERESFORD, P.: Poverty and Disabled People:Challenging Dominant Debates and Policies. In:Disability and Society 11(4), 1996: 553-567BLOCH, J. and BLOCH, M.: Women and the Dialetics ofnature in eighteenth century French Thought. In:MacCormack, C./ Strathern M. (Eds.): Nature, Cultureand Gender. Cambridge 1980: 25-42CHAMBERS, R.: Who Really Counts? Putting the LastFirst. London 1996COLERIDGE, P.: Disability, Liberation andDevelopment. Oxford 1993CREWE, E./HARRISON, E.: Whose Development? AnEthnography of Aid. London/New York 2000DE GROOT, J.: Conceptions and Misconceptions: TheHistorical and Cultural Context of Discussion onWomen and Development. In: Afshared, H. (Ed.):Women, Development and Survival in The ThirdWorld. London 1991DE SOUSA SANTOS, B.: On OppositionalPostmodernism. In: Munck, R./ O’Hearn, H. (Eds.):Critical Development Theory Contributions to A NewParadigm. London/New York 1999DI LEONARDO, M. (Ed.): Gender at the Crossroads ofKnowledge: Feminist Anthropology in the PostmodernEra. London 1991EDWARDS, M./HULME, D.: Making a Difference:NGOs and Development in a Changing World.London 1992ESCOBAR, A.: Power and Visibility: Development andthe Intervention and Management of the Third World.In: Cultural Anthropology 3 (4), 1988: 428-43ENCOUTERING DEVELOPMENT: The Making andUnmaking of The Third World. New York: 1995.ESTEVA, G.: Development. In: Sachs, W. (Ed.): TheDevelopment Dictionary: A Guide to Knowledge asPower. London 1993FAGAN, G. H.: Cultural Politics and (Post) DevelopmentParadigm(s). In: Munck, R./O’Hearn, H. (Eds.):Critical Development Theory Contributions to a NewParadigm. London/New York 1999GARDNER, K./ LEWIS,D.: Anthropology, Developmentand the Postmodern Challenge. London 1996GRAMSCI, A.: Selections from the Prison Notebooks ofAntonio Gramsci. Ed., trans., Q. Hoare and G. N.Smith. London 1971HARRISS-WHITE, B.: Onto a Loser: Disability in India.In: Harriss-White, B./Subramanian, S. (Eds.): Ill farein India: Essays on India’s Social Sector in Honor ofS. Guhan. New Delhi 199973

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London and New York1999MASSETT, E./ WHITE, H.: Are chronically Poor Peoplebeing Left Out of Progress Towards the MillenniumDevelopment Goals? A Quantitative Analysis of OlderPeople, Disabled People and Orphans. In: Journal ofHuman Development 5 (2), 2004MOSELY, P.: Overseas Aid: Its Defence and Reform.Brighton 1987MOSSE, D.: Authority, Gender and KnowledgeTheoretical Reflections on PPA. In: ODI networkpaper 44. London 1994PARFITT, T.: The End of Development: Modernity, Post-Modernity and Development. London 2002PARPART, J.: Deconstructing the Development expert.Gender, Development and the Vulnerable Groups. In:Marchand, M. Parpart, J. (Eds.): Feminism andPostmodernism Development. London/New York1999POTTIER, J. (Ed.): Practising Development: SocialScience Perspectives. London 1993RICHARDS, P.: Cultivation: Knowledge or Performance?In: Hobart, M. (Ed): An Anthropological Critique ofDevelopment: The Growth of Ignorance. London1993SACHS, W. (Ed.): The Development Dictionary: A Guideto Knowledge as Power. London 1992SOBHAN, R.: Bangladesh and the world economic system:the crisis of external dependence. In: Alavi, H./Harriss, J. (Eds.): Sociology of ‘DevelopingSocieties’: South Asia. London 1989STIRRAT, R. L./HENKEL, H.: The Development Gift:The Problem of Reciprocity in the NGO World. In:Annals of The American Academy of Political andSocial Science 554 (1997): 66-80.YEO, R./MOORE, K.: Including Disabled People inPoverty Reduction Work: ‘Nothing About Us, WithoutUs’. In: World Development 31(3), 2003: 571-590.ZENE, C.: The Rishi of Bangladesh: A History ofChristian Dialogues. London 200474Zusammenfassung: Entwicklungsländer werden häufigals rückständig in Bezug auf die Wertschätzung vonInklusion dargestellt. Das Stigma, das der Behinderunganhaftet, scheint dort größer als in den Industrieländernzu sein. Die Autorin gesteht ein, dass knappe Ressourcendie Inklusion beeinträchtigen, betont jedoch, dass diesnicht unbedingt tiefere Vorurteile gegenüber Behindertenwiderspiegelt. Der Entwicklungsdiskurs hat die Kategoriedes unterentwickelten Anderen geschaffen, in der allemarginalisierten Menschen zusammenfasst werden. DieseBezeichnung ist jedoch ungeeignet, die verschiedenenErfahrungen und Bedürfnisse von Menschen mitBeeinträchtigungen abzubilden. Die Autorin stellt traditionelleUnterstützungsnetzwerke vor, die in vielenGesellschaften existieren, und schlägt vor, dassEntwicklungsprojekte auf diesen aufbauen sollten, anstattwestliche Modelle von Inklusion zu exportieren.Résumé: Cet article montre que les pays en voie de développementsont fréquemment décrits comme étant arriérésen ce qui concerne l`appréciation de l'inclusion. De plus,le stigmate, inhérent à l'infirmité, semble y être plusimportant que dans les pays industrialisés. L'auteuradmet que des ressources rares entravent l'inclusion, maiscependant souligne que cela ne reflète pas forcément lespréjugés profonds concernant l'infirmité. Le discours dudéveloppement a créé une catégorie des autres sous développésdans laquelle sont groupées toutes les personnesmarginalisées. Cette étiquette est cependant inappropriéepour reproduire les divers besoins et expériences de personnesayant des entraves. L'auteur présente des réseauxde soutien traditionnels qui existent dans beaucoup desociétés et propose que les projets de développementdevraient être construits sur ces réseaux au lieu d'exporterdes modèles occidentaux d'inclusion.Resumen: Los países en vías de desarrollo muchas vecesson vistos como países subdesarrollados con respecto a lainclusión. El discurso del desarrollo ha creado la categoríadel Otro Subdesarrollado, la cual contiene todos losseres humanos marginados. Pero esta categoría es inadecuadapara dar un imagen de los diferentes experienciasy necesidades de las Personas con Discapacidad. El autorconstata, que principalmente los pocos recursos en estospaíses frenan a la inclusión, mucho más que los prejuiciosexistentes, y él presenta redes de apoyo tradicionales ypropone, que los proyectos de desarrollo se orienten másen ellos, en vez de exportar modelos de inclusión occidentales.Autor: Dr. Tamsin Bradley ist Senior Lecturer an derLondon Metropolitan University und DisabilityCoordinator an der University of Greenwich.Anschrift: t.bradley@londonmet.ac.ukZeitschrift Behinderung und Dritte Welt 2/2005

SCHWERPUNKTTHEMADisabling Infant Hearing Loss in a Developing South AfricanCommunity: the RisksD. Swanepoel/S.R. Hugo/B. LouwLate identification of infant hearing loss leads to serious negative consequences for the individual, family and society. Incontrast, the early identification of hearing loss yields dramatic benefits, since infants whose hearing loss is identifiedbefore 6 months of age have significantly better language abilities compared to those whose hearing loss was identifiedlater. In developed countries early identification is becoming the de facto medical legal standard of care whilst in developingcountries it is not a healthcare priority at all. An intermediate solution for developing countries was suggested inthe form of targeted screening of infants at risk for hearing loss. Unfortunately very little epidemiological data is availableregarding the incidence of risks in developing communities. The current study therefore describes risks for disablinghearing loss amongst a group of 510 infants younger than 12 months and their caregivers attending immunisationclinics in a developing South African community. Results indicate that infants demonstrate an increased risk forcongenital and acquired disabling hearing loss in the developing community investigated. Poverty, low levels of education,and a high percentage of teenage pregnancies are all contributing environmental risks toward a higher risk for disablinginfant hearing loss. In addition to these environmental risks the incidence of risk indicators specifically identifiedfor hearing loss were also considerably higher in the investigated community compared to developed countries. The increasedrisk emphasises the need for further research and comprehensive screening programmes to address the silentepidemic of disabling infant hearing loss in developing countries.IntroductionUndetected hearing loss leads to irreversible language,speech and cognitive delays, with farreachingsocial and economic ramifications (Yoshinaga-Itano & Gravel 2001, JCIH 2000, Yoshinaga-Itano etal. 1998, Mohr et al. 2000). Significant delays in languagedevelopment and academic achievement havebeen reported widely for the majority of children withsensori-neural hearing losses (Carney & Moeller1998). These delays are documented for numerousaspects such as vocabulary development, grammaticalskills, concept attainment, social conversational skillsand development of literary skills. Children with congenitalbilateral severe-to-profound hearing loss who leavethe educational system at the age of 18 years demonstratean average middle-third to middle-fourth grade readinglevel and language abilities that are 50% to 90% of theirchronological age, equivalent to a 9 and 10-year-old(Yoshinaga-Itano & Gravel 2001). On average, childrenwith a hearing loss who are identified late (after 12months) exhibit a discrepancy of 40 to 50 points betweennonverbal performance test scores and language ability.Even for the children who score in the top 10% of this distribution,the nonverbal/language discrepancy average is20 points (Yoshinaga-Itano 2003). These reports andothers have provided conclusive evidence of the seriousnegative effect of late identification of a hearing loss.Fortunately early identification of hearing loss is aform of secondary prevention that yields dramaticbenefits, since infants whose hearing loss is identifiedbefore 6 months of age have significantly better languageabilities compared to those whose hearing loss wasidentified later (Yoshinaga-Itano et al. 1998, Moeller2000, Calderon & Naidu 2000). The reason for this isZeitschrift Behinderung und Dritte Welt 2/2005that intervention (hearing aid fitting and supportive services)before the age of 6 months, enables infants todevelop and maintain normal language skills on par withtheir cognitive development (Yoshinaga-Itano et al.1998). This is in stark contrast with the persistent languagedelay of two to four years for infants identified after6 months of age (Yoshinaga-Itano et al. 1998).In developed countries, like the USA and UK,where Universal Newborn Hearing Screening (UNHS)programmes are being implemented, early identificationof hearing loss has become the de facto medicallegal standard of care. In contrast screening for hearingloss in developing countries has remained a low priority.It is not uncommon to find that healthcare needs inmost of these countries are ranked into high and lowpriorities with emphasis on life-threatening conditionsand diseases such as diphtheria, tetanus, meningitis andHIV/Aids, whilst conditions perceived as non-lifethreateningsuch as hearing loss are neglected(Olusanya 2000). Although hearing loss is indeed not alife-threatening condition, it becomes a severe threat toessential quality of life indicators unless interventionoccurs early in infant development. It is thereforeunfortunate that the benefits of early identificationhave not been pursued successfully in developingcountries of the world.In an attempt to address the lack of hearingscreening programmes in developing countries theJoint Committee for Infant Hearing (JCIH) recommendeda more affordable intermediate option in the formof targeted Newborn Hearing Screening (NHS) (JCIH2002). Targeted NHS is based on the principle thatscreening a small number of infants with high risk indicatorswill yield a large number of infants with hearingloss. The JCIH 2000 position statement has compiled a75

SCHWERPUNKTTHEMAlist of risk indicators for hearing loss (JCIH 2000). Anumber of different studies conducted in developed nationshave reported that the at-risk population constitutesapproximately 10% of all births and accounts for approximately50% of infants with congenital hearing loss(Chu et al. 2003, Davis & Wood 1992, Watkin et al.1991; Mauk et al. 1991). This may therefore be viewed asan effective way to keep screening costs low whilst attaininga relatively high return of identified infants withhearing loss.In developing countries however no systematic studiesare available that have investigated the prevalence of riskfactors for hearing loss amongst the newborn population.Such data is essential before large-scale targeted NHS programmesare launched to ensure planning is based on researchevidence. This fact is further emphasized by the compoundingeffect of additional environmental risk factorsthat may well make developing populations more prone tohaving a hearing loss. The prevalence of congenital hearingloss has recently been demonstrated to be associatedwith deprivation, which is characteristic of developingcountries (Kubba et al. 2004).The fact that the majority of children with hearing losslive in developing countries emphasises the necessity foreffective and accountable screening programmes built onaccurate data for these communities (WHO 1997). This isparticularly true of South Africa, a country characterisedby pockets of developed areas but where the majority ofthe population live in poverty in urban, peri-urban andrural areas (Fair & Louw 1999). Although epidemiologicaldata for developmental risk conditions in South Africa isincomplete and difficult to obtain, it is clear that there is anincreased prevalence of risk conditions for infants andyoung children (McPherson & Swart 1997).The Professional Board for Speech Language andHearing Professions of the Health Professions Councilof South Africa (HPCSA) has recently produced a positionstatement in which it recommends targeted NHSas an intermediate step towards Universal NHS inSouth Africa (HPCSA, 2002). One of the major screeningcontexts proposed were in line with the primaryhealthcare philosophy of the country in the form ofimmunisation clinics distributed throughout SouthAfrican communities. Before such widespread targetedscreening is implemented, however, it is essential thatresearch be conducted to address the dearth of informationregarding the incidence of risk factors for hearingloss amongst communities in South Africa. Thisdata will ensure that informed and accountable decisionsare made toward better hearing healthcare in SouthAfrica and other developing countries. The currentstudy therefore aimed to describe the risk factors, includingenvironmental risks, for hearing loss identified in agroup of caregivers and infants attending immunisationclinics in a developing South African community.76MethodThe institutional review board at the University ofPretoria approved this project before any data wascollected.SubjectsNeonates/infants younger than 12 months and theircaregivers served as paired research subjects. Caregiverswere considered to be the person responsible for bringingthe neonate/infant to the immunisation clinic. Subjectshad to be registered patients of the Refentse andEersterus immunisation clinic in the Hammanskraaldistrict and a file had to be available for each participant.These two clinics were selected because both centersprovide services to significant numbers of infants representingtypical developing contexts in South Africa. 510infants between the age of 0-12 months and with an evengender distribution (51/49%) were enrolled in the study.The mean age of the group was 14 weeks with 68% ofinfants younger than 16 weeks (4 months). The majorityof infants were younger than or equal to 10 weeks of agewith a large proportion (26%) of infants screened beingyounger than one month of age. The subject race wasalmost exclusively black (n=508) with the exception oftwo coloured infants. This is in agreement with thedemographical indicators specified for this community,which is predominantly representative of black SouthAfricans (Tshwane 2020 Plan 2002). The mere fact thatthese infants are born as black South Africans placesthem in the least developed group of South African citizenswith 66% of black South Africans living in povertycompared to less than 2% of white households, 8% ofAsian households and 25% of coloured households(Woolard & Barberton 1998). In addition to this the factthat the infants are from the Hammanskraal district alsoplaces them at an increased risk since it is a developingcontext characterised by socio-economic strains(Tshwane 2020 Plan 2002).Data collection materialA structured interview schedule was compiled toobtain a profile of biographical characteristics and riskindicators for hearing loss from the sample of subjects.The schedule constituted two sections which formedpart of the recording sheet and was completed by interviewingthe caregiver supplemented by informationfrom the immunisation clinic file. The first section consistedof biographical type questions. The second sectionof the interview schedule was a risk indicatorchecklist for hearing loss. The list of risk indicatorswas compiled from the JCIH 1994 and 2000 positionstatements (JCIH 2000). Widespread in-utero infectionsthat are characteristic of South Africa were alsoadded to the list and included HIV and malariaZeitschrift Behinderung und Dritte Welt 2/2005

SCHWERPUNKTTHEMA(Department of Health 2000, Department of Health2001). HIV has become a pandemic in South Africawith 1 in every 9 South Africans being infected(Department of Health 2002). The children born ofHIV/AIDS infected mothers are at increased risk forhearing loss due to significantly lower birth weights,increased vulnerability for acquiring infections such asmeningitis and cytomegalovirus (Spiegel & Bonwit2002). Malaria was included as a risk indicator because itis particularly dangerous for pregnant women, the medicationsfor treatment are ototoxic, and many regions of SouthAfrica are malaria prone (Claesen et al. 1998). The riskindicator questions were in the format of a checklist requiringa yes, no, or information unavailable choice.ProcedureAll data was collected in Hammanskraal at the twoMCH clinics. The research was conducted over a fivemonthperiod from mid January to mid June 2003. TheRefentse MCH clinic was visited on Mondays,Tuesdays, and Wednesdays whilst the Eersterus MCHclinic was visited on Thursdays and Fridays. Datacollection was not done every day over the five-monthperiod due to practical schedule considerations. Thefollowing procedure was used to obtain information.The interview was conducted as part of a routine hearingscreening protocol conducted at these clinics forresearch purposes. Two of the fieldworkers were able tospeak one or more African languages and these individualsassisted if the caregiver could not understand Englishor Afrikaans. In some instances information could not beobtained for all questions. The number of acquired responsesis therefore specified for each result.ResultsPrimary caregiver and marital status of motherSingle mothers were the primary caregivers in 82% ofcases with both parents involved for only three cases. Thesecond largest numbers of primary caregivers were thegrandparents, who comprised 14% of the sample. Theremainder stayed with extended family (2%) or with thefather (1%). In addition to this only 18% of the mothersof the neonates and infants were married.Age of mothers and number of childrenThe age of mothers of infants in this study variedbetween 15 to 43 years. Figure 1 provides the distribution(in percentage) of mothers for different age categories.It is clear that the majority of mothers are intheir late teens and early twenties. 58% of the motherswere 25 years of age and younger with almost twothirds(29%) of mothers 20 years of age and younger.A majority (72%) of the mothers had 1 or 2 children.This corresponds to the high percentage of young100%90%80%70%60%50%40%30%20%10%0%29%youngerthan 2158%youngerthan 2677%youngerthan 31mothers in the sample who had their first or secondchild. 21% of mothers were 19 years of age and youngermeaning that they were still school-going age and29% were 20 years of age and younger.Educational qualifications of parentsThe highest educational qualifications attained bythe group of mothers and fathers are presented inFigure 2.The majority (52%) of mothers had a grade 10 to 12educational qualification. A significant percentage(26%) of the fathers had obtained less than a grade 8school qualification and this figure rises to 47% if allfathers with a less than a grade 11 school qualificationare considered. In general, the fact that the number ofresponses for paternal educational qualifications ismuch less than for the mothers and that caregivers,who were mostly mothers, reported the fathers’ qualificationsmust be considered as possible factors whichmay have affected the results.Average household incomeThe distribution of average household incomesrecorded for this study is presented in Figure 3.A significant majority of respondents (77%) reportedan average monthly household income less than93%youngerthan 36Age in years98% 100%youngerthan 41youngerthan 43FIGURE 1. Frequency distribution of mothers accordingto age (n=510)60%50%40%30%20%10%0%16%Mothers (n=507)Fathers (n=199)26%29%21%52% 53% 3% 2%< Gr. 8 Gr.8 - 10 Gr.10 - 12 Diploma/DegreeFIGURE 2. Educational qualifications of mothers(n=507) and fathers (n=199)Zeitschrift Behinderung und Dritte Welt 2/200577

SCHWERPUNKTTHEMAR1000 (±US$ 154) (US$ 1.00 = ± R 6.50). Only asmall minority (5%) reported an average monthly householdincome of more than R2000 (±US$ 308).According to the 1996 Census, African women earnedthe least with 47,5% earning less than R500 per monthand a further 21,4% earning between R500 and R1000(Census 1996). This is comparable to the results in thecurrent study with 44% of households earning less thanR500 per month and a further 33% earning betweenR500 and R1000. The only difference is that this datacomes from seven years after the census date. Also, thefact that inflation has taken its toll over these years,exacerbates the picture of poverty in Hammanskraal.Risk indicators for hearing lossA summary of the incidence of risk factors is presentedin table 1.Risk indicators were reported for all categories exceptmeningitis. The cases where no information regardingrisk factors was available either in the clinic file or fromthe caregiver varied between 0,3 and 1,8% across the differentrisk categories. In the majority of these cases arelative brought the infant and the mother was not presentto provide all the required information. The high responserate for reporting risk indicators indicates promise forthe effective use of a high risk register for this populationin an immunisation clinic.In the current study 21% of infants (106/510) presentedwith at least one risk factor for hearing loss. 11,3% ofthese at-risk infants had more than one risk factor meaningthat 2,4% of infants tested had more than one riskfactor for hearing loss. The risk factor with the highestincidence was family history of congenital hearing loss(13%) followed by congenital infections (5%), NICUadmittance (2,4%), ototoxic medication (1,2%), low birthweight (1%), craniofacial defects (1%), asphyxia (0,8%),persistent pulmonary hypertension (0,4%), presence of asyndrome (0,2%) and hyperbilirubinaemia (0,2%). Therisk factors present in the group of NICU infants (n=12),from most prevalent to least, included low birth weight(n=5), asphyxia (n=4), ototoxic medication (n=4), familyhistory (n=2), and craniofacial defects (n=1).The sub-sample of infants who had been admitted to78R1001-200018%R501-100033%R2000-R50005%R0-50044%FIGURE 3. Average monthly household income(n=184)the NICU (n=12) presented with 17% of the documentedrisk factors (apart from the NICU as risk factor), despiteonly comprising 2,4% of the entire sample (n=510). Thismeans that risk factors in this study were 10 times (1/1,5)more prevalent in the NICU population than in non-NICU exposed infants (1/0,15). Since NICU admittancewas considered as a risk factor by itself in the currentstudy the incidence of risk factors for this sample, inactual fact, was 16 times (1/2,5) more prevalent in theNICU population than for the rest of the sample (1/0,15).Five of the NICU infants (42%) exhibited at least twoadditional risk factors in addition to NICU admittance.This is compared to only one infant (1%) from the non-NICU exposed at-risk group (n=94), presenting withmore than one risk factor. This makes NICU infants inthis study 42 times more likely to have more than onerisk indicator apart from NICU admittance.DiscussionEnvironmental risksThe description of infants and caregivers sampledfor this study indicates that this developingHammanskraal population is a predisposed high-riskgroup. South Africa has seen an increase in femaleheadedhouseholds with a staggering 42% of SouthAfrican children younger than seven years of agereported in 1995 to be living only with their mother(Nyman 1999). The figure is almost twice as high inthe current study. Possible reasons for the high percentageof single mothers in the current study left to careRISK INDICATOR RESULT DESCRIPTIONa) Family History of childhood hearingYES 13 %loss (n=501)NO 87 %No info 0.4 %b) Hyperbilirubinaemia (n=500)c) Congenital infections (n=495)d) Craniofacial defects (n=506)e) Birth weight less than 1500 grams(n=503)f) Bacterial meningitis (n=500)g) Asphyxia (n=500)h) Ototoxic medication (n=504)i) Persistent pulmonary hypertension.YES 0.2 %NO 98.6 %No info 1.2 %YES 5 %NO 95 %YES 1 %NO 99%YES 1 %NO 99 %No info 0.2 %YES 0 %NO 99.4 %No info 0.6 %YES 0.8 %NO 97.8 %No info 1.4 %YES 1.2 %NO 97 %No info 1.8 %YES 0.4 %Prolonged mechanical ventilation ≥ 5 NO 98.6 %days (n=504) No info 1 %j) Syndrome present (n=504)YES 0.2 %NO 99.8 %k) Admitted to the NICU for more than YES 2.4 %48 hours (n=505) NO 97.6 %65 subjects reported a familyhistory of childhood hearing lossOnly 1 subject had reported highbilirubinaemia levels and only thissubject had the levels availableSyphilis – 17Rubella – 1HIV – 57 subjects – atresia and ear tags6 subjects weighed less than1500 grams and info wasunavailable for 1No subjects reported bacterialmeningitis3 subjects had a 1 min Apgarless than 4 and 1 subject had a 5min Apgar less than 66 subjects were reportedlyexposed to ototoxic medication2 subjects were reported to havepersistent pulmonaryhypertension1 subject had a syndrome –Albinism12 subjects were admitted to theNICU for between 3 and 30 daysTABLE 1. Summary of the risk indicators for thesampleZeitschrift Behinderung und Dritte Welt 2/2005

SCHWERPUNKTTHEMAfor the children are probably due to the following reasons:(1) it is a peri-urban developing communityrepresenting the most underprivileged sections of theSouth African population; (2) high numbers of childrenare born out of formal partnerships; (3) high numbersof pregnancies among teenagers in temporary relationships;(4) a number of South African men establishdual households (Tshwane 2020 Plan 2002, Children in2001). It is therefore not uncommon for grandparentsto be the primary caregivers of children in South Africa(Children in 2001). This may often also be due to themother and/or father working far away from home ordue to death, which is increasingly becoming the casewith the spreading HIV/Aids pandemic (Children in2001). In this light it is not surprising that grandparentsare playing an increasing important part in caring forthe children of South Africa.These factors are risk factors that have importantimplications for screening and intervention programmessince effective early intervention is heavily reliant onparental or caregiver involvement (JCIH, 2000). Singlemothers and grandparents are under increasing straindue to economic pressure and the breakdown of thefamily structure and single parenthood places a child atan increased risk for developmental delays (Children in2001). In addition to this, the breakdown of family structurescreate stressors, which could seriously impede thenurturing of family-centred intervention programmes forinfants identified with hearing loss.Another stressor is the high incidence of teenagepregnancies. The obtained percentage closely approximatesthe estimated South African average of 19% offemale learners (18 years of age) and 30% of females19 years of age who have been pregnant at least once(Bhana 2004. Department of Health 1999). The highincidence is not surprising considering a 41% sexuallyactive teenage population in South Africa exacerbatedby limited use of contraceptives (Bhana 2004). It is acommon fact in maternal and child health programmesthat the youngest mothers are at the highest risk foradverse reproductive and parenting outcomes (Venturaet al. 1998). The high rate of teenage pregnancies inthis study therefore increases the risk of developmentaldisabilities in this community. This is even more so dueto an increased low-birth weight incidence present inadolescent mothers, which already predisposes theinfant to developmental disorders such as hearing loss(Northern & Downs 2002). Another factor that must beconsidered is the increase in school dropout ratesamong adolescent mothers, which adds to the economicburden of the household and limits future prospectsdue to poor education (Children in 2001).Another important environment risk factor is evidentin the poor educational levels of parents in the currentstudy. Previous reports have indicated that one inZeitschrift Behinderung und Dritte Welt 2/2005five African females have had no education at all(Central Statistics 1998). There has, however, been asteady improvement in educational qualificationsamong South Africans with a reported 28% of Africansbetween 20-24 years of age having obtained at least agrade 12 qualification (Central Statistics 1998). Veryfew post grade 12 educational qualifications werereported for both fathers and mothers. According to alarge study with a cohort of 17,091 infants and caregiversin Hawaii the mothers who had not completedhigh school were less likely to have their infant completethe hearing screening/follow-up process thanwere more educated women (Prince et al. 2003).Educational level is therefore significantly correlatedto the completion of a screening/follow-up process.The poor level of education and subsequent highvulnerability to unemployment are factors that placethe population of infants in this study at an increasedrisk for developmental delays and disabilities as well asfor poor involvement of parents in the early hearingloss detection and intervention process (Prince et al.2003). A related environmental risk indicator for thecurrent sample is the extreme poverty evident in households.Poor households have less access to essentialservices such as water and sanitation, communications,roads and energy sources, particularly in rural and periurbanregions such as Hammanskraal (Children in2001). These factors create enormous time burdens onpoor households and promise to be serious barriers tothe implementation of family-centred early interventionservices for infants with hearing loss. On the otherhand, poverty related stressors also place this populationof infants at an increased risk for developmentaldelays and disabilities such as hearing loss (Kubba etal. 2004), which emphasises the need for early detectionand intervention programmes.Risk indicators for hearing lossThe percentage of high risk factors for hearing loss(21%) recorded in this study is considerably higherthan previous reports in developed countries. Kennedyet al. (1998) reported that 11,6% of a sample of 21,279infants in England had risk factors for congenital hearingloss. A larger study (n=283,298) from the USAreported a 9% incidence of risk factors and a morerecent report indicated a 13.1% incidence of one ormore risk indicators in a sample (n=2701) of infantsfrom well-baby nurseries (Mahoney & Eichwald 1987,Vohr et al. 2000). Reasons for the high incidence ofinfants with risk factors in the current study were discussedin previous paragraphs and relate to the highincidence of a family history of hearing loss in thestudy sample.Except for family history of congenital hearingloss, the incidence distribution of existing risk indica-79

SCHWERPUNKTTHEMAtors in the current study was similar to previousreports. Kennedy et al. (1998) in a sample of 21,279infants reported incidences of 6,6% for family historyof hearing loss; 4,2% for congenital infections; 1% forasphyxia; 0,2% for chromosomal abnormalities; and0,3% for exchange transfusion due to high bilirubinaemialevels. The fact that family history was the mostprominent risk factor in this study is similar to previousstudies investigating large samples of infants differingonly by the incidence margin (Mahoney & Eichwald1987, Kennedy et al. 1998, Vohr et al. 2000). Previousstudies have reported a 6 to 7% incidence of familyhistory of congenital hearing loss compared to the 13%reported in the current study (Mahoney & Eichwald1987, Kennedy et al. 1998, Vohr et al. 2000).The high incidence of family history of congenitalhearing loss in the current study may be explainedby two possible factors. Firstly, depravity isknown to correspond with increased incidence rates ofcongenital hearing loss (Kubba et al. 2004) and thereforethe existing depravity in this community as evidencein discussion of subaim #1 can contribute to thishigh incidence of family history with congenital hearingloss. The second reason relates to the difficulty inobtaining an accurate history of family hearing lossand the importance of correctly phrasing the questionto avoid misunderstandings or erroneous responses(Cone-Wesson et al. 2000, Kountakis et al. 2002,Northern & Downs 2002). It is possible that caregiversmisunderstood or misinterpreted the posed questionand gave an incorrect answer, which may have inflatedthe incidence slightly. This risk factor, however, is veryimportant since it is commonly reported as the mostprevalent (22 – 42%) risk factor in at-risk childrenidentified with hearing loss and therefore accuratedocumentation of its presence is essential (Vohr et al.1998, Mahoney & Eichwald 1987). This emphasisesthe importance of parent or caregiver education andcounselling about the increased risk for hearing losswhen there is a family history.Another important aspect requiring consideration isthe incidence of congenital infections reported bymothers in this study. Due to the HIV/Aids pandemicin South Africa, with an estimated 11,4% of the generalpopulation infected, HIV was included as one of thecongenital infection risk factors for infants in this study(Department of Health, 2002). Children born ofHIV/Aids infected mothers are at increased risk forhearing loss due to significantly lower birth weights,increased vulnerability for acquiring infections such asmeningitis and cytomegalovirus (Spiegel & Bonwit2002). These children are also at a much greater risk ofdeveloping otitis media, which results in conductivehearing loss that may lead to sensori-neural hearingloss in certain cases (Bam, Kritzinger & Louw 2003,Matkin et al. 1998, Singh et al. 2003).The fact that only five mothers, comprising only1% of the sample, indicated that they were HIV infectedcompared to a reported 26,5% of women attendingimmunisation clinics in South Africa being infected,indicates gross underreporting in the current study(Mngadi 2003). According to the estimated averagerate of HIV infection in this population of mothersapproximately 135 should have reported being infected.This under reporting can be ascribed to a numberof reasons including unawareness among mothersregarding their status or reluctance to disclose suchinformation due to a fear of isolation or social stigma.ConclusionNeonates and infants demonstrate an increased riskfor congenital and acquired disabling hearing loss inthe developing community investigated. Poverty, lowlevels of education, and a high percentage of teenagepregnancies all contribute toward a higher risk for disablinginfant hearing loss. In addition to these environmentalrisks the risk indicators specifically identifiedfor hearing loss are also considerably higher than indeveloped countries. Infectious diseases such asHIV/Aids further increase the risks for disabling infanthearing loss especially in light of the reluctance todisclose HIV status by mothers. These higher risksemphasises the need for comprehensive screening programmesthat are contextually and culturally suited toaddress the silent epidemic of disabling infant hearingloss in developing countries.LiteraturBAM, I./ KRITZINGER, A./ LOUW, B.: Die vroeë kommunikasieontwikkelingvan ‘n groep babas met pediatrieseMIV/VIGS in sorgsentrums. In: Health SAGesondheid, 8(2), 2003: 34-47BHANA, R.: Youth risk behaviour. In: South AfricanHealth Review 2003/04. URL: http://www.hst.org.za/publications/423 (Date of access: 3 August 2004)CALDERON, R./ NAIDU, S.: Further support of the benefitsof early identification and intervention withchildren with hearing loss. In: Volta Review, 100(5),2000: 53-84CARNEY, A.E./ MOELLER, M.P.: Treatment efficacy:hearing loss in children. In: Journal of SpeechLanguage and Hearing Research, Suppl. 41 (1998):61-84CENSUS 1996: Population Census for South Africa.http://www.statssa.gov.za/census96/html (Date ofaccess: 16 August 2004)CENTRAL STATISTICS: Living in South Africa:Selected findings of the 1995 October household survey.Pretoria 1998, 1-44CHILDREN IN 2001: A Report on the State of theNation’s Children. Department of Health. Pretoria80Zeitschrift Behinderung und Dritte Welt 2/2005

SCHWERPUNKTTHEMA2001CHU, K./ ELIMIAN, A./ BARBERA, J./ OGBURN, P./SPITZER, A./ QUIRK, J.G.: Antecedents of NewbornHearing Loss. In: Obstetrics and Gynecology, 101(2003): 584-588CLAESEN, F.A.P./ VAN BOXTEL, C.J./ PERENBOOM,R.M./ TANGE, R.A./ WETSEIJN, J.C.F.M./ KAGER,P.A.: Quinine pharmacokinetics: ototoxic and cardiotoxiceffects in healthy Caucasian subjects and inpatients with falciparum malaria. In: TropicalMedicine and International Health, 3(6), 1998: 482-489CONE-WESSON, B./ VOHR, B.R./ SININGER, Y.S./WIDEN, J.E./ FOLSOM, R.C./ GORGA, M.P./ NOR-TON, S.J.: Identification of neonatal hearing impairment:Infants with hearing loss. In: Ear & Hearing,21(5), 2000: 488-507DAVIS, A.C./ WOOD, S.: The epidemiology of childhoodhearing impairment: factors relevant to planning ofservices. In: British Journal of Audiology, 26 (1992):77-90DEPARTMENT OF HEALTH: South AfricanDemographic and Health Survey. 1999. URL:http://www.doh.gov.za/facts/1998/sadhs98/ (Date ofaccess: 17 August 2004)DEPARTMENT OF HEALTH: Prevention of hearingimpairment due to otitis media. The Primary HealthCare Package for South Africa – a set of norms andstandards. 2000. URL: http://www.doh.gov.za/docs/policy/norms/part1t.html (Date of access: 17 August2004)DEPARTMENT OF HEALTH: Guideline for the preventionof hearing impairment due to otitis media at cliniclevel. 1-22. 2001. URL: http://www.doh.gov.za/docs/factsheets/guidelines/hearing.pdf (Date ofaccess: 21 October 2003)DEPARTMENT OF HEALTH: National HIV andSyphilis Sero-prevalence Survey of Women AttendingPublic Antenatal Clinics in South Africa – 2001.Summary Report. 2002. URL:http://www.doh.gov.za/docs/reports/2000/hivreport.html (Date of access: 23 October 2003)FAIR, L./ LOUW, B.: Early communication interventionwithin a community-based intervention model inSouth Africa. In: The South African Journal ofCommunication Disorders, 46 (1999): 13-23HEALTH PROFESSIONS COUNCIL OF SOUTHAFRICA: Professional Board for Speech, Languageand Hearing Professions: Hearing Screening PositionStatement Year 2002: 1-8JOINT COMMITTEE ON INFANT HEARING: Year2000 position statement: Principles and guidelines forearly hearing detection and intervention programs. In:American Journal of Audiology, 9 (2000): 9-29KENNEDY, C.R./ KIMM, L./ DEES, D.C./ EVANS,P.I.P./ HUNTER, M./ LENTON, S./ THORNTON,R.D.: Otoacoustic emissions and auditory brainstemresponses in the newborn. In: Archives of Disease inChildhood, 66 (1991): 1124-1128KOUNTAKIS, S.E./ SKOULAS, I./ PHILLIPS, D./Zeitschrift Behinderung und Dritte Welt 2/2005CHANG, C.Y.J.: Risk factors for hearing loss inneonates: a prospective study. In: American Journal ofOtolaryngology, 23(3), 2002: 133-137KUBBA, H./ MACANDIE, C./ RITCHIE, K./ MACFAR-LANE, M.: Is deafness a disease of poverty? Theassociation between socio-economic deprivation andcongenital hearing impairment. In: InternationalJournal of Audiology, 43 (2004): 123-125MAHONEY, T.M./ EICHWALD, J.G.: The ups and“DOWNS” of high-risk hearing screening: the Utahstatewide program. In: Seminars in Hearing, 8 (1987):55-164MAUK, G. W./ WHITE, K. R.: Giving children a soundbeginning: the promise of universal newborn hearingscreening. In: The Volta Review, 97 (1995): 5-32MATKIN, N.D./ DIEFENDORF, A.O./ ERENBERG, A.:Children: HIV/AIDS and Hearing Loss. In: Seminarsin Hearing, 19(2), 1998: 143-154MCPHERSON, B./ SWART, S.M.: Childhood hearingloss in sub-Saharan Africa: a review and recommendations.In: International Journal of PediatricOtorhinolaryngology, 40 (1997): 1-18MNGADI, S.: HIV prevalence in South Africa.Spokesperson for the Minister of Health. 3 July 2003.URL: http://www.doh.gov.za/docs/pr/2003/pr0703.htmlMOELLER, M.P.: Early intervention and language developmentin children who are deaf and hard of hearing.In: Pediatrics, 106(3), 2000: 1-9MOHR, P.E./ FELDMAN, J.J./ DUNBAR, J.L.: The societalcosts of severe to profound hearing loss in theUnited States. Policy Analysis Brief: Project HopeCenter for Health Affairs. April 2000: 1-4NORTHERN, J.L./ DOWNS, M.P.: Hearing in Children.5th ed. Baltimore MA 2002NYMAN, R.: The tender years in a harsh society. In:Rights Now, 6 (1999): 4-5OLUSANYA, B.O.: Hearing impairment prevention indeveloping countries: making things happen. In:International Journal of PediatricOtorhinolaryngology, 55 (2000): 167-171PRINCE, C.B./ MIYASHIRO, L./ WEIRATHER, Y./HEU, P.: Epidemiology of early hearing loss detectionin Hawaii. In: Pediatrics, 111(5), 2003: S1202-1206SPIEGEL, H.M.L./ BONWIT, A.M.: HIV infection inchildren. In: Batshaw, M.L. (Ed.): Children withDisabilities. 5th ed. Baltimore 2002. 123-139SINGH, A./ GEORGALAS, C./ PATEL, N./ PAPESCH,M.: ENT presentations in children with HIV infection.In: Clinical Otolaryngology & Allied Sciences, 28 (3),2003: 240-243TSHWANE 2020 PLAN: Integrated development plan:first revision. 2002. URL: http://www.tshwane.gov.za/documents/idp2020/index.htm (Date of access: 15September 2004)VENTURA, S.J./ CURTIN, S.C./ Mathews, T.J.: Teenagebirths in the United States: national and state trends,1990-1996. National Vital Statistics System.Hyattsville, MD: National Center for Health Statistics.12/98VOHR, B.R./ CARTY, L.M./ MOORE, P.E/81

SCHWERPUNKTTHEMALETOURNEAU, K.: The Rhode Island HearingAssessment Program: Experience with statewide hearingscreening (1993-1996). In: The Journal ofPediatrics, 133(3), 1998: 353-357VOHR, B.R./ WIDEN, J.E./ CONE-WESSON, B./ SIN-NINGER, Y.S./ GORGA, M.P., FOLSOM, R.C./NORTON, S.J.: Identification of neonatal hearingimpairment: Charactersitics of infants in the neonatalintensive care unit and well-baby nursery. In: Ear &Hearing, 21 (2000): 373-382WATKIN, P.M./ BALDWIN, M./ MCENERY, G.:Neonatal at risk screening and the identification ofdeafness. In: Archives of Diseases in Childhood, 66(1991): 1130-1135WOOLARD, I./ BARBERTON, C.: The extent of povertyand inequality. In: Barberton, C./ Blake, M. & Kotzé,H. (Eds.): Creating Action Space. Cape Town 1998.13-39YOSHINAGA-ITANO, C./ SEDEY, A./ COULTER, D./MEHL, A.: Language of early- and later-identifiedchildren with hearing loss. In: Pediatrics, 102 (1998):1161-1171YOSHINAGA-ITANO, C./ GRAVEL, J.S.: The evidencefor universal newborn hearing screening. In: AmericanJournal of Audiology, 10 (2001): 62-64YOSHINAGA-ITANO, C.: Universal newborn hearingscreening programs and developmental outcomes. In:Audiological Medicine, 1 (2003): 199-206Zusammenfassung: Die späte Diagnose von kindlichenGehörschädigungen hat ernste Folgen für das Individuum,die Familie und die Gesellschaft. Im Gegensatzdazu hat die Früherkennung großen Nutzen, da Kinder,deren Hörschaden vor dem Ende des sechsten Lebensmonatsentdeckt wird, deutlich bessere Sprachfähigkeitenhaben, als solche, bei denen die Gehörschädigung erstspäter festgestellt wird. Während in Industrieländern dieFrüherkennung medizinischer Standard ist, hat sie inEntwicklungsländern keine Priorität. Daher wurde hierein Mittelweg vorgeschlagen, in Form eines Früherkennungsprogrammsfür besonders gefährdete Kinder. Leiderliegen jedoch nur sehr wenige Daten über das Auftretenvon Risiken in developing communities vor. Die vorliegendeStudie beschreibt anhand einer Gruppe von 510Kindern unter einem Jahr und ihren Erziehungsberechtigtendie Risiken für Gehörschädigungen bei Kindern.Armut, geringe Bildung und Teenager-Schwangerschaftenerhöhen demnach die Risiken für einen Hörschadenbeträchtlich. Der Befund verdeutlicht die Notwendigkeitweiterer Forschung sowie umfassender Früherkennungsprogramme,um der stillen Epidemie kindlicherGehörschädigungen in Entwicklungsländern Einhalt zugebieten.Résumé: Le diagnostic tardif des dommages de l'ouiechez les enfants a des conséquences sérieuses pour l`individu,la famille et la société. En revanche, le dépistageprécoce présente un grand avantage, car les enfants, dontles problèmes auditifs sont découverts avant la fin de leursixième mois, présentent des compétences linguistiques82beaucoup plus marquées que ceux chez qui des dommagesde l'ouie ont été constatés plus tard. Alors que dans lespays industriels le dépistage précoce est chose normale,celui-ci n'a aucune priorité dans les pays en voie de développement.C'est la raison pour laquelle un compromis aété proposé sous la forme d'un programme de dépistageprécoce pour les enfants spécialement en danger.Malheureusement, il n'existe, cependant, que très peu dedonnées sur l'apparition des risques dans les developingcommunities. L'étude en cours décrit, en s'appuyant surun groupe de 510 enfants ayant moins d'un an et les personneschargées de leur éducation, le risque de dommagesde l'ouie chez les enfants. Pauvreté, manque de formation,grossesses d'adolescentes augmentent considérablementles risques de dommage de l'ouie. Le résultatindique la nécessité d'une recherche continue ainsi quedes programmes de dépistage précoce pour mettre fin àcette épidémie rampante de dommage de l'ouie infantiledans les pays en voie de développement.Resumen: El diagnóstico temprano de la DeficienciaAuditiva es muy importante porque mejora significativamentela posibilidad de elaborar la capacidad para ellenguaje del niño con deficiencia auditiva. Mientras queen los países industrializados el diagnóstico temprano esstandard médico, en los países en vías de desarrollo notiene prioridad. Por eso se propone aqui un camino mediode forma de un programa de diagnóstico temprano paraniños con alto riesgo. El estudio presentado describe através de un grupo analizado de 510 niños con menos deun año y sus padres los riesgos para las deficiencias auditivasde niños. Pobreza, falta de educación y embarazosde adolescentes aumentan la deficiencia auditiva notablemente.Este resultado enseña la necesidad de otros estudiosy de la implementación de programas de diagnósticostempranos para frenar a la epidémia silenciosa de ladeficiencia auditiva de los niños en los países en vías dedesarrollo.Autor: Dr. De Wet Swanepoel ist Audiologe und Leiterder Elektrophysiologischen Klinik der Universität vonPretoria, Südafrika. Dort hat er sich auf die Früherkennungund Überwachung von Gehörschädigungenbei Kindern spezialisiert. Zudem berät er den HealthProfessions Council of South Africa hinsichtlich derEntwicklung und Durchführung von Programmen zurUntersuchung des Hörvermögens von Kindern. Er leitetzahlreiche Forschungsprojekte, die die Realisierbarkeitvon Früherkennungsprogram-men in Entwicklungsländernwie Südafrika untersucht.Anschrift: Department of Communication Pathology,University of Pretoria, South Africa, Pretoria 0002,Tel: 27 12 4202949, Fax: 27 12 4203517, E-Mail:dswanepoel@postino.up.ac.zaZeitschrift Behinderung und Dritte Welt 2/2005

BERICHTEEmpowerment and DisabilityReporting from the International DCDD Symposium Disability, Self-organisation and AidOn November 15th, 2004, 150 people from seventeencountries got together in The Hague/Netherlands to discuss empowerment for people withdisabilities. The central question was how donor organisationscould best support self-organisations of disabledpeople in developing countries and throughoutEastern Europe. The symposium participants agreedthat there is an urgent need for donors to address theissue of mobilization and emancipation of people withdisabilities more effectively.DCDD – Dutch Coalition on Disability andDevelopment – was the organiser of this symposiumand invited speakers from the World Bank, PSO (theNetherlands), Handicap International and SHIA(Sweden) to give plenary contributions in the morning.In the afternoon, six workshops were given by leadersof grassroots disability organisations from Uganda,Swaziland, Kenya, India, Bosnia-Herzegovina andBulgaria. This article highlights some of the issues discussedand specifically reports on how donor organisationscan work on capacity building of disabled peopleorganisations. The full report of the symposium can bedownloaded on DCDD's website (www.dcdd.nl).Often disability is still seen as a medical issue insteadof a human rights issue. But, the emphasis should be oninclusion rather than on disability. It's about equal participationin society, not about rehabilitation alone.What kind of approach?At the symposium there was much debate on thebest approach to empowerment, a needs driven or apolicy driven approach. Needs are assessed by askingthe target group different variations of the general question"what do you need/want?" The policy drivenapproach makes use of preset priorities in grant makingdecisions. The main problem with utilising a needs drivenapproach is that a more global perspective and alongerterm view prioritizing development-orientateditems (such as access to education or to independentliving) is usually not taken. Instead the focus is onimmediate needs such as food or (higher) income, andif possible, on demanding free transport (instead ofaccessible). For a practical example see the boxDangers of a needs driven approach. A lot of mistakescan be avoided if development interventions use a combinationof the two approaches.Disability: an unrecognised problemDisabled people are highly discriminated againstwhen it comes to access to education, employment,health etc. The groups most affected are disabledwomen and children and especially intellectually disabledpeople. To fight poverty and exclusion, a complexchain of different components is needed. Besides directpoverty alleviation measures, advocating the rights ofpeople with disabilities is a key strategy. In many developingcountries the belief and practice that disability isan NGO matter is dominant and therefore usually doesnot get financed through government. Poverty alleviationstrategies of most foreign donor organisations,however, are rarely directed towards people with disabilities.Though some donors promote the mainstreamingof disability, their actual knowledge about disabilityis limited and there is little sharing of experience.Empowerment, what is needed?The symposium did not attempt to answer the question:"What is Empowerment?" but tried to identifythe most important elements needed when empoweringpeople with disabilities. It is obvious that the corevalue – "nothing about us without us" –should not beneglected. Disabled people and their grassroots organisationsare stakeholders in the development process,and should be empowered and, perhaps, even educatedto see development from a longer-term perspective.Zeitschrift Behinderung und Dritte Welt 2/2005Disabled people organisations (DPOs)There is a need to make more resources availablefor the capacity building of organisations of disabledpeople in developing countries. But, there is currently atendency in donor organisations to allocate resources toorganisations that are already empowered and forgetabout those that still need capacity building. By supportingDPOs, donor organisations could help them toidentify their needs and priorities.Donors however, need to take into account that theDangers of a needs driven approachThere is a widespread "fashionable" practice of settingup day care centres for children with disabilities inmany countries, which is frequently justified by the needsof the parents. Time and again the needs assessmentsamong parents show that what they need most is qualifiedmedical and psychological care for their disabledchildren. Also fundraising for this purpose is much easierfor donor organisations in their countries of origin.However, in practice, the day care centres actually becomespecialised institutions and, as a result, disabledchildren are being isolated from their peers, their educationis usually of a poor quality and the time spent at theday care centre does not prepare children for adulthood.The day care centres example shows us how internationaldonors can give money that meets the identifiedneeds of the target group but that this money does notnecessarily contribute to the equalisation of opportunitiesnor to entitlement to human rights.83

BERICHTEcurrent education system in many countries is groundedin a system that segregates disabled people.Special schools that exist have very limited capacity.Mainstream schools are almost never accessible forchildren with disabilities. This results in the exclusionof a vast majority of learners with disabilities fromaccessing education, thus very few disabled peoplegain access to higher education. Leadership and managementof DPOs is therefore an issue that requires specificattention. In Eastern Europe the situation differsfrom that in developing countries. Most of the DPOleaders in Eastern Europe still have a centralist systemmindset, trying to keep or recover what they had,instead of looking for a new system that is more inclusivethan protective.Disability on the PRSP agendaPRSPs (Poverty Reduction Strategy Papers) are a keygovernment policy instrument for poverty reductionand are seen as the operational framework for implementingthe Millennium Development Goals (MDGs). PRSPshave put poverty reduction at the centre of developmentplanning. There is an increase in the number of PRSPs inwhich disability is mentioned, but this is only partial progress.Disabled persons still remain largely invisible inPRSPs. The result is an incomplete policy agenda: in67% of the PRSPs, disability is only mentioned as a socialprotection measure. PRSP measures to economicallyintegrate disabled people are rare.It is at the level of disability policies that PRSPs facetheir greatest challenge: PRSP programs need to betranslated into annual government budgets but there is astrong risk that the initial policy commitment will evaporate.Data show that in only approximately one third of theplanned interventions in social protection, education andhealth, are targets and budgets allocated. There are threekey constraints hindering the participation of disabledpeople in poverty alleviation: they are economically excludedfrom pro-poor growth, there is social exclusion fromeducation and health and they have a weak politicalvoice. The weak political voice of disabled people (organisations)is a concern. Associations representing disabledpeople are consulted in only a few cases, in 29% ofPRSPs, and in the follow-ups, like the policy discussionsof PRSPs, they are rarely involved at all.Evidence from the PRSPs studied shows that whenDPOs participate in PRSP consultation, the social focusof disability policy on social protection measures decreasesand the economic focus increases, and the problemis analysed more in terms of a list of human potential.DPOs should be involved not only in the preparation ofPRSPs, but also during the policy discussions. Capacitybuilding may be required: training in advocacy (for example,how to formulate economic argument for disabilitypolicy), and financial support.Central values for donor organisations whenworking with DPOsWhen it comes to development in the disabilityarena, donor agencies should both adopt and encouragea policy driven approach that utilises the vision of anaccessible social and physical environment, equalopportunities and independent living. Donor organisationsshould promote advocacy activities that represent84social justice, so that the questions related to disabilityare taken into account at each stage of the decisionmaking process. More attention, coordination andexchange are essential because the disability movementis still weak; this is exacerbated by the competitionand the struggles which exist amongst DPOs.Donors should ensure more consistent and longer-termsupport for programmes. They should ensure better followupof implemented projects for special groups ofbeneficiaries, instead of frequently changing the focusonto groups they want to support. Donors are alsodependent on DPOs for their own improvement, forexample, donors need information from DPOs to be ina position to manage the programmes better. Donorsshould avoid over-funding, they should not alwaysdraw on the same faces. Many DPOs are new organisationsand lack professional expertise. It is necessary,for example, to avoid jargon as this can be an obstacleto getting grants. Grant application formats should beaccessible. The keyword is collaboration, use strengthsfrom both sides.A unified voice: common issues to work onHow can DPOs motivate mainstream NGOs towork with disabled people? Go and meet the NGOs! Inthis case people with disabilities can really contributeinstead of (being seen as) only draining family resources.A big challenge for DPOs is that their voice shouldinclude all categories of disabled persons at all levels.And, only a unified voice on key issues among peoplewith disabilities can achieve significant change.Therefore DPOs should work on key issues together.For example getting disability on the PRSP agenda(see box Disability on the PRSP agenda), or joiningefforts in raising awareness about the international(UN) convention on the protection and promotion ofthe rights and dignity of persons with disabilities.Learn from developments in other areas, for examplefrom HIV/Aids, which is now understood more accuratelyas a human rights issue. Northern and SouthernDPOs could work together on certain issues. The basefor common understanding between them is verystrong and could stimulate joint action.More attention on empowermentThe symposium demonstrated that there is anurgent need for donor organisations to work more onthe empowerment of people with disabilities.Disability is a human rights issue and donor organisationsshould help DPOs to built capacity and to betteradvocate access to human rights for disabled peoplethroughout their region or country. In this way, disabledpeople can make a real difference and contributeequally to the development of their society.Mark RaijmakersZeitschrift Behinderung und Dritte Welt 2/2005

VERANSTALTUNGENVERANSTALTUNGEN18.09.-13.10.2005 International Course in CBR Management, Alphen aan den Rijn, NiederlandeInformation: Enablement, Huib Cornielje, Langenhorst 36, 2402 PX Alphenaan den Rijn, Niederlande, Tel: ++31-172-436953, Fax: ++31-172-244976, E-Mail: h.cornielje@enablement.nl, www.enablement.nl26.09.-29.09.2005 International Symposium "Inclusion and the Removal of Barriers to Learning,Participation and Development", Bakittingi, West Sumatra, IndonesiaInformation: Braillo Norway, P.O.Box 1365 JKS, 12013 Jakarta, Indonesia,symposium2005id@idp-europe.org, www.idp-europe.org30.09.-01.10.2005 "Our Rights - Our Future" - International Conference of World Federation ofthe Deaf, Helsinki, FinnlandInformation: Tel.: +358-9-4542190, Fax: +358-9-45421930,www.wfdhelsinki2005.org17.10.-18.10.2005 Disability: A global perspective on rights to education and livelihoods,Bangkok/ThailandInformation: Leonard Cheshire International, Fiona McConnon, 30 Millbank,London SWIP 4QD, Großbritannien, Tel: +44-20-7802 8217, Fax: +44-20-7802 8275, Email: Fiona.McConnon@lc-uk.org, http://lcint.org.uk17.10.-19.10.2005 International Conference on Accessible Tourism, Nairobi/KeniaInformation: Kenya Disabled Development Society, P.O.Box 40500-00100GPO, Nairobi/Kenya, Tel.: +254-20-826185, Fax : +254-20-821375,Email: bodo@avu.org, http://rdi.pl/kdds21.10.2005 7. RC-Forum: Zwischen Ideologie und Realität: Enthospitalisierung in EuropaInformation: REHA CONSULT e.V., Lenther Steig 8, 13629 Berlin,Tel.: +49-30-38305467, Fax: +49-30-38305358, E-Mail: ina.rieck@rehaconsult.org,www.rehaconsult.org04.11.-06.11.2005 Entwicklungszusammenarbeit als soziale Aufgabe und praktische Erfahrung -Teil II. Aufbauseminar zur Vorbereitung von Arbeits-, Praktikums- undStudienaufenthalten in Afrika, Asien und Lateinamerika in Kooperation mit derAkademie Frankenwarte in WürzburgInformation: Behinderung und Entwicklungszusammenarbeit e.V.09.12.-11.12.2005 Seminar für RückkehrerInnen: Entwicklungszusammenarbeit als sozialeAufgabe und praktische Erfahrung - Teil III in Kooperation mit der AkademieFrankenwarte in WürzburgInformation: Behinderung und Entwicklungszusammenarbeit e.V.06.01.-07.01.2006 EU-India Conference: Circles of Support (CoS) in India and the EU - towardsperson-centred community inclusion networks in Bhubaneswar, IndienInformation: Prof. Dr. Evamarie Knust-Potter, Fachhochschule Dortmund,Emil-Figge-Str. 44, 44227 Dortmund,Tel.: +49 231 755 5192, Sekr.: +49 231 755 6832, Fax: +49 231 755 6833, E-mail: knust-potter@fh-dortmund.de, Internet: www.cos-transnational.netFür weitere Veranstaltungen auf dem Gebiet der Entwicklungszusammenarbeit weisen wir auf den RundbriefBildungsauftrag Nord-Süd des World University Service hin. Bezug: World University Service,Koordinationsstelle Nord-Süd im Bildungsbereich, Goebenstraße 35, 65195 Wiesbaden,http://www.tu-darmstadt.de/wusgermany.Zeitschrift Behinderung und Dritte Welt 2/200585

NEWSDemolition of poor people'shomes and market stalls inZimbabweThe Southern Africa Federation of the Disabled(SAFOD) is "appalled and disgusted" by the destruction ofpeople's homes and businesses by the ZimbabweanGovernment in the so-called clean-up campaign "OperationMurambatsvina" (translated as "drive out the rubbish"). Thecampaign, that started in May, has seen thousands of peopleliving in the urban areas of the country being evicted fromtheir homes and market stalls. During the forced evictionswhich are being carried out without notice and without courtorders, police and other members of the security forces havebeen using excessive force to either burn ur pull downhomes and informal market stalls, destroying property, andbeating up individuals. In Harare alone, the capital city ofZimbabwe, an estimated 300 000 families have so far beendisplaced by the clean-up campaign, and there are policethreats that this campaign will spread to other areas beyondthe urban centres.SAFOD are particularly concerned with the situation ofdisabled men and women, and their families, who have beenaffected by this diabolic operation. Being the poorest of thepoor, a majority of disabled urban dwellers were living in thetype of housing units that were destroyed. For those whowere running small businesses such as fruit and vegetablestalls, hair salons, flea markets, etc., also had their businessesdestroyed. The forced destruction and/or closure of informalbusinesses and settlements has obviously worsened thesituation of disabled people and their families in the country.Quelle: SAFODbezev-Preis für wissenschaftlicheArbeiten zum Thema Behinderungund EntwicklungszusammenarbeitNEWSGoals (MDGs), der internationalen Entwicklungszieleziehen. Diese sehen unter anderem vor, die Zahl der inabsoluter Armut lebenden Menschen bis zum Jahre 2015zu halbieren oder allen Kindern eine Primarschulbildungzukommen zu lassen. Obwohl die internationalenEntwicklungsziele für Menschen mit Behinderung vonbesonderer Relevanz sind, finden sie darin keineErwähnung.Welche Bedeutung die MDGs für Menschen mitBehinderung haben, zeigt die Wanderausstellung ,Es istan der Zeit...’ auf, die von Behinderung und Entwicklungszusammenarbeit(bezev) im Rahmen des ProjektesArmut - Behinderung - Entwicklung erarbeitet worden ist.Die Ausstellung hat im Vorfeld der UN-Zwischenkonferenzbereits wichtige Stationen durchlaufen, um daraufhinzuweisen, dass Menschen mit Behinderung bei derUmsetzung internationaler Vereinbarungen nicht vergessenwerden dürfen. So ist sie bereits im Bundesministeriumfür wirtschaftliche Zusammenarbeit und Entwicklung(BMZ) in Bonn, der Kreditanstalt für Wiederaufbau(KfW) in Frankfurt, bei InWEnt in Bonn, dem Ministeriumfür Umwelt und Naturschutz, Landwirtschaft undVerbraucherschutz des Landes Nordrhein-Westfalen oderdem Tag der Begegnung in Xanten zu sehen gewesen. ImSeptember wird die Ausstellung im Eine Welt Haus inMünchen sowie bei InWEnt in Bad Honnef gezeigt.Wenn Sie die Ausstellung gerne in Ihre Stadt holenmöchten, nehmen Sie bitte Kontakt mit bezev auf. DerVerleih der Ausstellung (inkl. einer umfangreichenBegleitbroschüre) ist kostenlos. Weitere Informationenzur Ausstellung sowie die aktuellen Ausstellungsterminefinden Sie auf der bezev-Homepage (www.bezev.de), woSie sich die Ausstellung auch vorab online ansehen können.Kontakt: Behinderung und Entwicklungszusammenarbeit(bezev), Wintgenstr. 63, 45239 Essen, Tel.: 0201/4087 745, Fax: 0201/40 87 748, E-Mail: info@bezev.deDer bezev-Preis für hervorragende wissenschaftlicheArbeiten zum Thema Behinderung und Entwicklungzusammenarbeitwird jährlich verliehen. Eingereicht werden könnenDiplom-, Zulassungs- und Magisterarbeiten, die andeutschen Universitäten oder Fachhochschulen vorgelegtund nicht älter als zwei Jahre sind. Genauere Informationenerhalten Sie im bezev-Regionalbüro Süd.Kontakt: Behinderung und Entwicklungszusammenarbeit,Regionalbüro Süd, Heike Fischer, Kidlerstr. 24,81371 München, E-Mail: fischer@bezev.deWanderausstellung zu MDGs undBehinderungIm September 2005 werden die Staats- und Regierungschefsauf einer UN-Konferenz eine Zwischenbilanzder im Jahre 2000 vereinbarten Millennium DevelopmentBelgischer Senat verbietetStreubombenDer belgische Senat hat im Juli einem Gesetzentwurfzum Verbot der Herstellung, Lagerung und Verbreitungvon Streubomben zugestimmt. Nach dem Abwurf verteilendiese Bomben Hunderte von Sprengkörpern überFlächen in der Größe von mehreren Fußballfeldern. Vieleder Bomben explodieren beim Aufprall nicht und werdendamit de facto zu Anti-Personen-Minen, die unterschiedslosLeid über Soldaten und Zivilisten bringen. DieStreitkräfte der USA und Großbritanniens haben 2003 biszu zwei Millionen Streubomben über dem Irak abgeworfen,von denen nach Schätzungen zwischen 100.000 und600 000 heute noch immer herumliegen. Ohne massiveRäumungsprogramme werden sie früher oder später vonZivilisten ausgelöst. Während in vielen Ländern inzwischenparlamentarische Initiativen zum Verbot von86 Zeitschrift Behinderung und Dritte Welt 2/2005

NEWS & LITERATURStreubomben ergriffen wurden, stellen 34 Staaten weiterhinStreubomben her, darunter auch die Deutschland.Quelle: Handicap International"Treffpunkt Eine Welt"Jugendliche und junge Erwachsene, die mittels Begegnungen,Praktika oder längerfristigen Freiwilligendienstenfremde Länder kennen lernen möchten, finden Tipps,Termine, Informationen und Adressen in der Broschüre"Treffpunkt Eine Welt 2005/2006". Die Broschüre kostetbei Einzelbestellungen 2,80 Euro. Bei größeren Bestellungengibt es Preisnachlass.Weitere Informationen: www.dieeinewelt.de,E-Mail: info@dieeinewelt.de, Tel.: 030 - 61074815.Quelle: LHÜ-Info, Mai 2005Stellenmarkt GlobalDie Stellendatenbank des Arbeitskreises Lernen undHelfen in Übersee (AK LHÜ) unter www.oneworldjobs.orgenthält zurzeit mehr als 1 800 Angebote. Dabeihandelt es sich zum einen um Stellen in der Entwicklungszusammenarbeit,im Entwicklungsdienst und imZivilen Friedensdienst. Zum anderen werden internationaleFreiwilligendienste, Workcamps und Praktikaangeboten. Etwa 130 Anbieter sind aktuell in der Datenbankregistriert. Die Angebote sind überwiegend sozialeund entwicklungspolitische Tätigkeiten in Afrika, Asien,Lateinamerika und Osteuropa.Quelle: LHÜ-Info, Juli 2005Neue Datenbank vereinfachtRecherche zu entwicklungspolitischenThemenEntwicklungspolitische Zeitschriften sind der aktuellePulsmesser entwicklungspolitischer Diskussion. Doch siesind auch mehr: ein lebendiges Gedächtnis der Arbeit. Inder Kooperation mit Hochschulen, Schulen u.a. werdenNROs und Initiativen immer wieder nach inhaltlichfundierten Beiträgen gefragt. Im Herbst 1998 haben sichdaher elf Archive und Dokumentationszentren zurKooperation Dritte Welt Archive zusammengeschlossen.Ergebnis dieser Vernetzung ist das Archiv³, eine neugestaltete Datenbank, mit deren Hilfe eine einfacheRecherche zu entwicklungspolitischen Themen möglichist. Die gesammelten Materialien und Informationen sindin anderen Dokumentationszentren und Bibliothekenkaum erhältlich. Auch deswegen ist die Datenbank füreine globalisierungskritische und entwicklungspolitischeBildungs- und Öffentlichkeitsarbeit äußerst wertvoll. Mitkomfortablen Bestellmöglichkeiten bietet sie einenschnellen Zugriff auf einen Informationsschatz, der imInternet sonst nur über umständliche Recherchen oderZufallstreffer zu finden ist. Der Datenbestand umfasstzurzeit gut 150.000 Zeitschriftenartikel und "graueLiteratur". Weitere Infos: www.archiv3.org.Frist, TomDon't treat me like I have leprosy2003ISBN: 094754325 2LITERATUR & MEDIENBezug: ILEP, 234 Blythe Road, London, W 14 0HJ,GroßbritannienIn recent years, medical science has won a series of greatvictories over leprosy. Since the introduction of Multi-Drug Therapy (MDT) in the early 1980s, millions of peoplehave been cured; and we know much more about theepidemiology of the disease, and about how to prevent thedisabilities associated with it.Yet such medical advances have not been accompanied byprogess i tackling the psycho-social problems caused byleprosy. These include disability, social stigma, segegation- and the poverty that is the inevitable consequence.Millions of peple who have been medically cured remainaffected by these problems.This highly readable book looks at the progress that hasbeen made in the battle against leprosy, and outlines boththe challenges and the way ahead in the fight for socialand economic integration. It will be of value not only tothose wishing to look at leprosy from a non-medicalviewpoint, but to those working with other stigmatisingconditions who would like to share the experience ofothers in fighting social isolation.Zeitschrift Behinderung und Dritte Welt 2/2005SINTEFLiving Conditions among People with ActivityLimitations in Zimbabwe. A representative regionalsurvey2003ISBN 82-14-03242-3This research report provides results from a study on livingconditions among people with and without activitylimitations in Matabeleland, Manicaland and Midlands,Zimbabwe. The study began in 2001 and was completedin 2003.Bezug: SINTEF Unimed, P.O.Box 124, Blindern, 0314Oslo, Norwegen, Tel.: ++47 22 06 73 00, Fax: ++47 22 0679 09, www.sintef.no87

LITERATUR & STELLENANZEIGENHoogeven, J.H.Measuring Welfare for Small but Vulnerable Groups,Poverty and Disability in UgandaWorld Bank, 2004When vulnerable population groups are numerically small- as is often the case, obtaining representative welfareestimates from non-purposive sample surveys becomes anissue. Building on a method developed by Elbers,Lanjouw and Lanjouw (2003) it is shown how, for censusyears, estimates of income poverty for small vulnerablepopulations can be derived by combining sample surveyand population census information. The approach is illustratedfor Uganda, for which poverty amongs householdswith disabled heads is determined. This is possibly thefirst time that, for a developing country, statistically representativeinformation on income poverty amongst disabledpeople is generated.Bezug:http://www-wds.worldbank.org/servlet/WDSContentServer/WDSP/IB/2004/10/14/000090341_20041014091219/Rendered/PDF/301680SP004190.pdfJones, Hazel & Reed, BobWater and Sanitation for disabled people and othervulnerable groups2005Over 500 million people in the world are disabled, themajority of whom live in poverty in low-income communities.A major contributing factor to the poverty of disabledpeople is their lack of access to sanitation and safewater. The Millennium Development Goals of povertyreduction, health and access to safe water and sanitationwill be difficult to achieve equitably without addressingthe access needs of disabled people. Many other vulnerablegroups also experience difficulties using water andsanitation facilities, such as frail, elderly people, pregnantwomen, parents with small children, and people who areinjured or sick - including people with AIDS. Despite thesize of the problem, almost nothing has been published onthis subject to date, and disabled people continue to beignored by providers of water and sanitation services.Based on three years of international research withWATSAN and disability sector organizations, this bookfills a significant gap in knowledge.Bezug: WEDC Publications, Loughborough University,Leicestershire, LE11 3TU, Großbritannien, Tel.: ++44 (0)1509 222618, Fax: ++44 (0) 1509 211079,E-Mail: K.J.Betts@lboro.ac.uk,Internet: http://www.lboro.ac.uk/wedc/publications88Zeitschrift Behinderung und Dritte Welt 2/2005

Netzwerk Menschen mit Behinderung in der Einen WeltMenschen mit Behinderung in der Einen Welt ist einNetzwerk von Organisationen und Einzelpersonen,die sich wissenschaftlich und/oder praktisch mit demThema Behinderung in der so genannten DrittenWelt auseinander setzen. Mitglieder des Netzwerkskönnen sein: Organisationen der Entwicklungszusammenarbeit,Institutionen, Arbeitsstellen anStudienstätten, Arbeitskreise und Arbeitsgruppen,Fachkräfte aus dem entwicklungspolitischen sowiebehinderungsspezifischen Kontext sowie an derThematik interessierte Einzelpersonen. Das Netzwerkist ein Kommunikationsforum, das die wissenschaftlicheund praxisorientierte Auseinandersetzungzur Thematik fördern und unterstützen will.Dies wird umgesetzt durch die ihm angehörendenMitglieder.AnschriftDas Netzwerk übernimmt die folgenden Aufgaben:- Herausgabe der Zeitschrift Behinderung undDritte Welt- Durchführung gemeinsamer Veranstaltungen(z.B. Symposia)- Koordinationsstelle für an der ThematikInteressierte- Vermittlung von Kontakten- Diskussionsforum zu relevanten Fragestellungen- Zweimal im Jahr Netzwerktreffen in unterschiedlichenRegionen Deutschlands- VernetzungNetzwerk Menschen mit Behinderung in der Einen Weltc/o Behinderung und Entwicklungszusammenarbeit e.V.Wintgenstr. 63, 45239 EssenTel.: 0201/40 87 745, Fax: 0201/40 87 748, Email: bezev@t-online.deInternet: www.bezev.deSchwerpunktthemen kommender Ausgaben derZeitschrift Behinderung und Dritte Welt3/2005 Regionale Perspektiven der Behindertenarbeit (Asien) - (verantwortlich: Mirella Schwinge/Susanne Arbeiter)1/2006 Menschen mit Behinderung in der humanitären Hilfe (verantwortlich: Gabriele Weigt)2/2006 Wege zur Einkommensförderung für Menschen mit Behinderung in EntwicklungsländernInteressierte Autorinnen und Autoren werden aufgefordert, nach vorheriger Rücksprache mit der Redaktionhierzu Beiträge einzureichen. Darüber hinaus sind Vorschläge für weitere Schwerpunktthemen willkommen.Einsendeschluss für BeiträgeAusgabe 3/2005 Ausgabe 1/2006 Ausgabe 2/2006Hauptbeiträge 15. Juli 2005 15. November 2005 15. Februar 2006Kurzbeiträge 15. August 2005 15. Dezember 2005 15. März 2005Liebe Leserinnen und Leser,bitte informieren Sie uns über eine eventuelle Adressenänderung oder wenn Sie die Zeitschrift nicht mehrbeziehen möchten. Geben Sie uns bitte ebenso Bescheid, falls Ihnen die Zeitschrift nicht zugestellt wordenist.Zeitschrift Behinderung und Dritte Welt 2/200589

Zeitschrift Behinderung und Dritte WeltBehinderung und Dritte Welt ist die Zeitschrift des Netzwerks Menschen mit Behinderung in der Einen Welt.Sie erscheint seit 1990 dreimal jährlich in einer Auflage von 850 Exemplaren und wendet sich v.a. andeutschsprachige Interessierte im In- und Ausland.Vor allem dank der Unterstützung der Bundesvereinigung Lebenshilfe e.V., Kindernothilfe e.V. undBehinderung und Entwicklungszusammenarbeit e.V. erreicht sie viele WissenschaftlerInnen, Fachleute undsonstige Interessierte in allen Kontinenten.Ihr Anspruch ist einerseits, ein Medium für einen grenzüberschreitenden Informationsaustausch zur Thematikdarzustellen und andererseits, die fachliche Diskussion zu pädagogischen, sozial- und entwicklungspolitischensowie interkulturellen Fragen im Zusammenhang mit Behinderung und Dritter Welt weiterzuentwickeln.Die Redaktion und der sie unterstützende Fachbeirat sind insbesondere darum bemüht, Fachleute aus allenTeilen dieser Erde hierfür zu gewinnen und einzubinden. Publikationssprachen sind Deutsch und Englisch;Beiträge in Französisch, Spanisch oder Portugiesisch werden nach Möglichkeit übersetzt. Das Profil derZeitschrift zeichnet sich durch jeweils ein Schwerpunktthema pro Ausgabe, eine über mehrere Hefte hinweglaufendeSchwerpunktserie sowie einen Informationsteil aus.Die Ausgaben der Zeitschrift Behinderung und Dritte Welt sind auch im Internet abrufbar unter:http://www.uni-kassel.de/ZBeh3WeltDie Zeitschrift Behinderung und Dritte Welt wird unterstützt durch:Bundesvereinigung LebenshilfeMisereorKindernothilfeBehinderung undEntwicklungszusammenarbeit e.V.90 Zeitschrift Behinderung und Dritte Welt 2/2005