Handicap International experience in Afghanistan - CBM

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.