Handicap International experience in Afghanistan - CBM

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A variety of subjects and fields addressed during the first week of training by the HI occupational therapist,physiotherapist and psychologist were:• Concept of disability, discussing definitions;• Physical and sensorial disabilities;• Mental disabilities;• Children with disability;• Interviewing techniques (attitudes, vocabulary, respect).Carrying out the FieldworkEach region was supervised by a Regional Team Manager (RTM), who was seconded by two Master Trainers/Monitors (MTM). These persons were in charge of the complete field organisation: contacting authorities,recruiting and training surveyors, organising transport, accommodation and security as well as carrying outthe quality check for the data.Each regionwas supervisedby a RegionalTeam Manager(RTM), who wasseconded by twoMaster Trainers/Monitors (MTM)Ensuring QualityThe most important aspect of data quality checking was to ensure that quality control was carried out atall stages of the survey. The first check was done in the cluster by the MTM in charge. This ensured that themissing information was minimal. The questionnaires were also checked for coherence by the RTM and theNDSA Project Manager before entering in the database. Lastly, there were random checks of selected villagesin each area to ensure that the data collected was valid. In at least 6% of the clusters, 5 – 10 householdssurveyed were re-checked by independent persons, not having participated in the survey.Data Processing and AnalysisThe data was processed using scanning software, Teleform Verity®. This ensured quick data entry whileminimising the human errors of a manual process. However, this software required a high level of technicalknowledge in order to utilise it efficiently. One of the main problems was the impossibility of recognising theDari and Pashto scripts, which delayed the printing of the completed questionnaires. The scanning processstarted in Kabul, in the WFP premises, which hosted the only copy of the software. Due to unavailability of theequipment, the work was finished in New Delhi, India where the Handicap International South Asian RegionalCoordination Office is based.The data analysis was carried out using the SPSS® software. A series of reports were produced as and whenthe data cleaning was completed and in view of the demands from the various stakeholders. These reportspresent the basic indicators regarding each section of the questionnaire as well as sex-disaggregated dataand analysis according to the different variables included in the questionnaire.4 Understanding 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 defining ‘disability’ for our purpose. In addition to conflict in the past, bad health care and generalpolitical instability, there are also strong beliefs of what these rates are, according to the various partnersworking on the field as well as donors and international agencies. It is interesting to note that internationallythere 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 in1992, this estimate was modified to 4% for developing countries and 7% for industrialised countries.” 3This section explains how disability is defined in the NDSA and in view of the objectives. It also argues thatestablishing any rigid definition is futile. Disability is a continuum, ranging from very severe difficulties infunctioning to very mild forms. Where we choose to put the threshold, depends closely on the context andthe aims of the exercise.Definitions of DisabilityThe variations observed in prevalence rates across countries can be explained by a number of factors. Thesocial beliefs and stereotypes related to disability vary, not only in terms of culture but also depending on thelevel of awareness and visibility of different types of disability. Lastly, the decision to include certain forms ofdisability is closely linked to diverse aspects of policies that are being implemented. Some surveys find veryhigh prevalence rates since they include various conditions (i.e., chronic illness) in the definition of disability.The NDSA screening was based on the International Classification of Functioning, 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 individuals in order tounderstand the disabling situation. For this survey the following definition was elaborated in line with the aimof providing knowledge and policy guidelines:“Disability is the condition that results from the interaction between an individualimpairment in functioning and the community and social resources, beliefs and practicesthat enable or prevent a person from participating in all spheres of social life and takingdecisions that are relevant to his/her own future.”The variationsobserved inprevalence ratesacross countriescan be explainedby a numberof factors. Thesocial beliefsand stereotypesrelated todisability vary,not only in termsof culture butalso dependingon the levelof awarenessand visibility ofdifferent types ofdisabilityPrevalence RatesThe prevalence of disability is the proportion of persons in the overall population that is considered to bedisabled. This rate is generally expressed as a percentage of the parent population; in this case the wholepopulation of Afghanistan. However, before presenting the tools through which this was done, it is importantto state that this rate changes and evolves and is closely linked to a number of factors:• Definition of disability and the choice to include/exclude certain forms of difficulties;• Level of awareness that exists within a given social and cultural context;3MITRA S. (2005), “Disability and Social Safety Nets in Developing Countries”, Social Protection Discussion Paper Series, No. 0509, May2005, Social Protection Unit, Human Development Network, The World Bank, Washington D.C.4World Health Organization (2001), International Classification of Functioning, Disability and Health, Geneva.
Page 3 and 4: Islamic Republic of AfghanistanUNDE
Page 5 and 6: ContentsAcknowledgementsAbbreviatio
Page 8: Figure 25 : Retention, Transition a
Page 11 and 12: AbbreviationsAFAs : AfghanisBPHS :
Page 13 and 14: PrefaceThe National Disability Surv
Page 15: IntroductionAs the process of recon
Page 18 and 19: Figure 1. Sampling Stages of NDSA1s
Page 22 and 23: • Beliefs and expectations of wha
Page 24 and 25: Prevalence Threshold with Regard to
Page 26 and 27: The proportion of persons with disa
Page 28 and 29: Mental disability shows a much more
Page 30 and 31: The effectiveprevalencerate of seve
Page 32 and 33: to a maximum of 37.4% unable to coo
Page 34 and 35: Table 3. Proportion of Persons with
Page 36 and 37: Table 4: Proportion of Persons with
Page 38 and 39: Figure 9. Distribution of Persons w
Page 40 and 41: Figure 12: Distribution of Persons
Page 42 and 43: Comparing the situation between mal
Page 44 and 45: Figure 17. Number of Visits to Heal
Page 46 and 47: Table 5: Yearly Average Expenses (A
Page 48 and 49: 32 Understanding the Challenge Ahea
Page 50 and 51: A crucial aspect that influences ac
Page 52 and 53: Table 6 highlights the advantage th
Page 54 and 55: Figure 26: Retention, Transition an
Page 56 and 57: to take this into consideration whe
Page 58 and 59: • Boys with physical disability a
Page 62 and 63: Figure 32: Distribution of Persons
Page 64 and 65: to others: usually they benefit fro
Page 66 and 67: Figure 37: Distribution of Active P
Page 70 and 71:
According to NRVA 2003, poverty is
Page 72 and 73:
means that the average living space
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Figure 43: Distribution of Persons
Page 76 and 77:
Figure 46: Distribution of Househol
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62 Understanding the Challenge Ahea
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The inability tobear children is am
Page 82 and 83:
The situation is somewhat different
Page 84 and 85:
Figure 51: Distribution of Persons
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706050• Landmine/UXO Survivors•
Page 88 and 89:
ConclusionInclusion is a major fact
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of persons with disability 48 . Thi
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GHOSH N., MOHIT A., MURTHY R.S. (20
Page 95:
The National Disability Survey in A
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Handicap International experience in Afghanistan - CBM

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