Handicap International experience in Afghanistan - CBM

• Beliefs and expectations of what these rates should be within a given context;• Formulation, wording and manner in which the questions are asked;• Underestimation of certain kinds of disability that may be hidden within a given culture (mentaldisability is often more difficult to detect adequately).As a result, prevalence rates fluctuate over time and according to the definition and typology that is used toestablish it.Lastly, it is essential to differentiate between “the incidence (the number of persons who were born or madedisabled), and the prevalence rate (the number who survive)” 5 . The NDSA did not ask questions regardingincidence of disability within the family.It becomesimportant to lookat disability as acontinuum thatranges from verysevere difficultiesto almost nodifficulties.Where theresearchers,policy makersor otherstakeholdersdecide to setthe thresholddepends upontheir aims andobjectivesSetting a Threshold: What does Disability Mean in a Given Context?Bearing these facts in mind it becomes important to look at disability as a continuum 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 Screening Questionnaire: 27 questionsFor a survey on disability that aims at establishing prevalence rates, as well as looking at the living conditionsof persons with disability, researchers needed to devise a screening methodology that was not based onthe judgment of one or more surveyors. The questions were determined according to different sections:physical, sensorial, psychological, intellectual and relational. These questions related to the concept of whatis ‘disabling’ to lead a fulfilling life within the community and in society. The designing of questions that werenot stigmatising and that were presented in a non-threatening manner for the interviewees and their familieswas a difficult task.For the NDSA the focus was placed upon the persons having very severe difficulties in everyday functioning,detected through a screening questionnaire: 27 questions grouped in 5 sections. The elaboration of the varioussections of the screening tool of the questionnaire was long and required consultation with a number of specialists.Each disability was screened through a specific question, studies having shown that the aggregation of severaldisabilities into one question leads to a serious underestimation of certain types of disability.Looking at Ability to do Things: 46 Questions on 9 DimensionsThe NDSA analysis was based upon the persons with severe difficulties who were detected through thescreening questions explained above. However, another possibility can be considered by using the section ofthe questionnaire that looks at the ability to do things. This was part of the health section and was not usedfor screening but it gives essential information that can be used to provide a different view of prevalence. Thissection consisted of 46 questions that were grouped into 9 dimensions for analysis:• The ability to take care of oneself on a day-to-day basis;• The ability to contribute to tasks within 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 interact and have social relations with people;• Intellectual and memorisation abilities;• The ability to have coherent individual 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 Afghanistan”, paper presented at theconference Disability issues: Global Solutions and the Role of Community-Based Rehabilitation Queen’s University, Kingston, Canada,March 5-6, 1998.6 Understanding the Challenge Ahead