A variety of subjects and fields addressed dur<strong>in</strong>g the first week of tra<strong>in</strong><strong>in</strong>g by the HI occupational therapist,physiotherapist and psychologist were:• Concept of disability, discuss<strong>in</strong>g def<strong>in</strong>itions;• Physical and sensorial disabilities;• Mental disabilities;• Children with disability;• Interview<strong>in</strong>g techniques (attitudes, vocabulary, respect).Carry<strong>in</strong>g out the FieldworkEach region was supervised by a Regional Team Manager (RTM), who was seconded by two Master Tra<strong>in</strong>ers/Monitors (MTM). These persons were <strong>in</strong> charge of the complete field organisation: contact<strong>in</strong>g authorities,recruit<strong>in</strong>g and tra<strong>in</strong><strong>in</strong>g surveyors, organis<strong>in</strong>g transport, accommodation and security as well as carry<strong>in</strong>g outthe quality check for the data.Each regionwas supervisedby a RegionalTeam Manager(RTM), who wasseconded by twoMaster Tra<strong>in</strong>ers/Monitors (MTM)Ensur<strong>in</strong>g QualityThe most important aspect of data quality check<strong>in</strong>g was to ensure that quality control was carried out atall stages of the survey. The first check was done <strong>in</strong> the cluster by the MTM <strong>in</strong> charge. This ensured that themiss<strong>in</strong>g <strong>in</strong>formation was m<strong>in</strong>imal. The questionnaires were also checked for coherence by the RTM and theNDSA Project Manager before enter<strong>in</strong>g <strong>in</strong> the database. Lastly, there were random checks of selected villages<strong>in</strong> each area to ensure that the data collected was valid. In at least 6% of the clusters, 5 – 10 householdssurveyed were re-checked by <strong>in</strong>dependent persons, not hav<strong>in</strong>g participated <strong>in</strong> the survey.Data Process<strong>in</strong>g and AnalysisThe data was processed us<strong>in</strong>g scann<strong>in</strong>g software, Teleform Verity®. This ensured quick data entry whilem<strong>in</strong>imis<strong>in</strong>g the human errors of a manual process. However, this software required a high level of technicalknowledge <strong>in</strong> order to utilise it efficiently. One of the ma<strong>in</strong> problems was the impossibility of recognis<strong>in</strong>g theDari and Pashto scripts, which delayed the pr<strong>in</strong>t<strong>in</strong>g of the completed questionnaires. The scann<strong>in</strong>g processstarted <strong>in</strong> Kabul, <strong>in</strong> the WFP premises, which hosted the only copy of the software. Due to unavailability of theequipment, the work was f<strong>in</strong>ished <strong>in</strong> New Delhi, India where the <strong>Handicap</strong> <strong>International</strong> South Asian RegionalCoord<strong>in</strong>ation Office is based.The data analysis was carried out us<strong>in</strong>g the SPSS® software. A series of reports were produced as and whenthe data clean<strong>in</strong>g was completed and <strong>in</strong> view of the demands from the various stakeholders. These reportspresent the basic <strong>in</strong>dicators regard<strong>in</strong>g each section of the questionnaire as well as sex-disaggregated dataand analysis accord<strong>in</strong>g to the different variables <strong>in</strong>cluded <strong>in</strong> the questionnaire.4 Understand<strong>in</strong>g the Challenge Ahead
SECTIONPrevalence and TypologyOverall Profiles of Afghans with Disability2How many Afghans have some form of disability? It is extremely perilous to answer this question withoutfirst def<strong>in</strong><strong>in</strong>g ‘disability’ for our purpose. In addition to conflict <strong>in</strong> the past, bad health care and generalpolitical <strong>in</strong>stability, there are also strong beliefs of what these rates are, accord<strong>in</strong>g to the various partnerswork<strong>in</strong>g on the field as well as donors and <strong>in</strong>ternational agencies. It is <strong>in</strong>terest<strong>in</strong>g to note that <strong>in</strong>ternationallythere have been attempts to set a standard for prevalence rates, which have so far been unsuccessful. “In1981 UN/WHO studies estimated that on an average 10% of national populations are disabled. However <strong>in</strong>1992, this estimate was modified to 4% for develop<strong>in</strong>g countries and 7% for <strong>in</strong>dustrialised countries.” 3This section expla<strong>in</strong>s how disability is def<strong>in</strong>ed <strong>in</strong> the NDSA and <strong>in</strong> view of the objectives. It also argues thatestablish<strong>in</strong>g any rigid def<strong>in</strong>ition is futile. Disability is a cont<strong>in</strong>uum, rang<strong>in</strong>g from very severe difficulties <strong>in</strong>function<strong>in</strong>g to very mild forms. Where we choose to put the threshold, depends closely on the context andthe aims of the exercise.Def<strong>in</strong>itions of DisabilityThe variations observed <strong>in</strong> prevalence rates across countries can be expla<strong>in</strong>ed by a number of factors. Thesocial beliefs and stereotypes related to disability vary, not only <strong>in</strong> terms of culture but also depend<strong>in</strong>g on thelevel of awareness and visibility of different types of disability. Lastly, the decision to <strong>in</strong>clude certa<strong>in</strong> forms ofdisability is closely l<strong>in</strong>ked to diverse aspects of policies that are be<strong>in</strong>g implemented. Some surveys f<strong>in</strong>d veryhigh prevalence rates s<strong>in</strong>ce they <strong>in</strong>clude various conditions (i.e., chronic illness) <strong>in</strong> the def<strong>in</strong>ition of disability.The NDSA screen<strong>in</strong>g was based on the <strong>International</strong> Classification of Function<strong>in</strong>g, Disability and Health 4 (ICF)as well as the capability approach used by the UNDP Human Development Report (HDR). These frameworkshelp to look, not only at the impairments, but also at the activities and participation of <strong>in</strong>dividuals <strong>in</strong> order tounderstand the disabl<strong>in</strong>g situation. For this survey the follow<strong>in</strong>g def<strong>in</strong>ition was elaborated <strong>in</strong> l<strong>in</strong>e with the aimof provid<strong>in</strong>g knowledge and policy guidel<strong>in</strong>es:“Disability is the condition that results from the <strong>in</strong>teraction between an <strong>in</strong>dividualimpairment <strong>in</strong> function<strong>in</strong>g and the community and social resources, beliefs and practicesthat enable or prevent a person from participat<strong>in</strong>g <strong>in</strong> all spheres of social life and tak<strong>in</strong>gdecisions that are relevant to his/her own future.”The variationsobserved <strong>in</strong>prevalence ratesacross countriescan be expla<strong>in</strong>edby a numberof factors. Thesocial beliefsand stereotypesrelated todisability vary,not only <strong>in</strong> termsof culture butalso depend<strong>in</strong>gon the levelof awarenessand visibility ofdifferent types ofdisabilityPrevalence RatesThe prevalence of disability is the proportion of persons <strong>in</strong> the overall population that is considered to bedisabled. This rate is generally expressed as a percentage of the parent population; <strong>in</strong> this case the wholepopulation of <strong>Afghanistan</strong>. However, before present<strong>in</strong>g the tools through which this was done, it is importantto state that this rate changes and evolves and is closely l<strong>in</strong>ked to a number of factors:• Def<strong>in</strong>ition of disability and the choice to <strong>in</strong>clude/exclude certa<strong>in</strong> forms of difficulties;• Level of awareness that exists with<strong>in</strong> a given social and cultural context;3MITRA S. (2005), “Disability and Social Safety Nets <strong>in</strong> Develop<strong>in</strong>g Countries”, Social Protection Discussion Paper Series, No. 0509, May2005, Social Protection Unit, Human Development Network, The World Bank, Wash<strong>in</strong>gton D.C.4World Health Organization (2001), <strong>International</strong> Classification of Function<strong>in</strong>g, Disability and Health, Geneva.