Handicap International experience in Afghanistan - CBM
Handicap International experience in Afghanistan - CBM
Handicap International experience in Afghanistan - CBM
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• Beliefs and expectations of what these rates should be with<strong>in</strong> a given context;• Formulation, word<strong>in</strong>g and manner <strong>in</strong> which the questions are asked;• Underestimation of certa<strong>in</strong> k<strong>in</strong>ds of disability that may be hidden with<strong>in</strong> a given culture (mentaldisability is often more difficult to detect adequately).As a result, prevalence rates fluctuate over time and accord<strong>in</strong>g to the def<strong>in</strong>ition and typology that is used toestablish it.Lastly, it is essential to differentiate between “the <strong>in</strong>cidence (the number of persons who were born or madedisabled), and the prevalence rate (the number who survive)” 5 . The NDSA did not ask questions regard<strong>in</strong>g<strong>in</strong>cidence of disability with<strong>in</strong> the family.It becomesimportant to lookat disability as acont<strong>in</strong>uum thatranges from verysevere difficultiesto almost nodifficulties.Where theresearchers,policy makersor otherstakeholdersdecide to setthe thresholddepends upontheir aims andobjectivesSett<strong>in</strong>g a Threshold: What does Disability Mean <strong>in</strong> a Given Context?Bear<strong>in</strong>g these facts <strong>in</strong> m<strong>in</strong>d it becomes important to look at disability as a cont<strong>in</strong>uum that ranges from verysevere difficulties to almost no difficulties. Where the researchers, policy makers or other stakeholders decideto set the threshold depends upon their aims and objectives.The Screen<strong>in</strong>g Questionnaire: 27 questionsFor a survey on disability that aims at establish<strong>in</strong>g prevalence rates, as well as look<strong>in</strong>g at the liv<strong>in</strong>g conditionsof persons with disability, researchers needed to devise a screen<strong>in</strong>g methodology that was not based onthe judgment of one or more surveyors. The questions were determ<strong>in</strong>ed accord<strong>in</strong>g to different sections:physical, sensorial, psychological, <strong>in</strong>tellectual and relational. These questions related to the concept of whatis ‘disabl<strong>in</strong>g’ to lead a fulfill<strong>in</strong>g life with<strong>in</strong> the community and <strong>in</strong> society. The design<strong>in</strong>g of questions that werenot stigmatis<strong>in</strong>g and that were presented <strong>in</strong> a non-threaten<strong>in</strong>g manner for the <strong>in</strong>terviewees and their familieswas a difficult task.For the NDSA the focus was placed upon the persons hav<strong>in</strong>g very severe difficulties <strong>in</strong> everyday function<strong>in</strong>g,detected through a screen<strong>in</strong>g questionnaire: 27 questions grouped <strong>in</strong> 5 sections. The elaboration of the varioussections of the screen<strong>in</strong>g tool of the questionnaire was long and required consultation with a number of specialists.Each disability was screened through a specific question, studies hav<strong>in</strong>g shown that the aggregation of severaldisabilities <strong>in</strong>to one question leads to a serious underestimation of certa<strong>in</strong> types of disability.Look<strong>in</strong>g at Ability to do Th<strong>in</strong>gs: 46 Questions on 9 DimensionsThe NDSA analysis was based upon the persons with severe difficulties who were detected through thescreen<strong>in</strong>g questions expla<strong>in</strong>ed above. However, another possibility can be considered by us<strong>in</strong>g the section ofthe questionnaire that looks at the ability to do th<strong>in</strong>gs. This was part of the health section and was not usedfor screen<strong>in</strong>g but it gives essential <strong>in</strong>formation that can be used to provide a different view of prevalence. Thissection consisted of 46 questions that were grouped <strong>in</strong>to 9 dimensions for analysis:• The ability to take care of oneself on a day-to-day basis;• The ability to contribute to tasks with<strong>in</strong> the household;• The ability to move around and contribute to tasks outside the house;• The ability to communicate with other members of the family and the community;• The ability to <strong>in</strong>teract and have social relations with people;• Intellectual and memorisation abilities;• The ability to have coherent <strong>in</strong>dividual behaviour;• The absence of depressive symptoms and signs of trauma and other psychological problems;• The absence of fits, seizures and signs of epilepsy.5COLERIDGE P. (1998), “Development, Cultural Values, and Disability, The Example of <strong>Afghanistan</strong>”, paper presented at theconference Disability issues: Global Solutions and the Role of Community-Based Rehabilitation Queen’s University, K<strong>in</strong>gston, Canada,March 5-6, 1998.6 Understand<strong>in</strong>g the Challenge Ahead