Handicap International experience in Afghanistan - CBM

More documents

Recommendations

Info

• 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
On each dimension the answers of respondents were rated from ‘very severe difficulties’ to ‘no difficulty’. Asa result, the higher the score on each dimension, the higher the level of difficulties the persons faced on thegiven dimension.Results regarding Prevalence RatesThe prevalence rate presented in this report and used for analysis, is based on the persons detected throughthe screening questionnaire and who have severe difficulties in everyday functioning.The prevalence of very severe disability identified by the screening tool of the survey stands at 2.7% ±0.2% (CI 95%). This represents a population between 550,000 and 643,800 Afghans based on Ministry ofPublic Health Population estimates 6 ; or a population between 747,500 and 867,100 if one considers UnitedNations Population Fund estimates 7 . Analysis based on the number of households, shows that on an average,1 out of every 5 households has at least one person with disability.This prevalence rate of 2.7% is in line with estimates that have already been put forward by the governmentas well as other organisations working in Afghanistan:Table 1. Prevalence Rates According to Various SurveysSources Year of Survey Prevalence RateUNDP/UNOPS 8 1991 3%, 700,000MICS(Multi Indicator Cluster Survey) 9 2003NRVA (National Risk and VulnerabilityAssessment) 10 20032.5% for children under 53% for persons between 7 and 172% for physical disability1% for mental disabilityNDSA 2005 2.7% for overall populationLooking at the Continuum: Where do we Place the Threshold?If disability is seen as a continuum of difficulties in functioning, ranging from very severe to mild, then theprevalence rate mainly depends upon where we choose to place the “cut off” or the threshold. As a result,persons falling within this limit will be considered disabled.Even though theNDSA estimatesthe proportionof the Afghanpopulation thaturgently needsto be targetedby public policiesand programmesto be at 2.7%,the prevalencerate will increaseaccording tothe inclusion ofpersons havingless severedifficultiesHowever, even though the NDSA estimates the proportion of the Afghan population that urgently needs tobe targeted by public policies and programmes to be at 2.7%, the prevalence rate will increase accordingto the inclusion of persons having less severe difficulties. As the understanding of disability, as well as theprovision of basic services improve, this additional proportion of persons will need to be taken into account,thus increasing the prevalence rates.6Based on total population estimate of 22.2 million according to Afghanistan Health Facts Sheet 2003-2004, Ministry of PublicHealth finalised November 2004. Official estimates from Ministry of Economy-Central Statistic Office are not yet available.7Based on total population estimate of 29.9 million according to United Nations Population Fund State of World Population 2005Report, The Promise of Equality Gender Equity, Reproductive Health and the Millennium Development Goals, September 2005.8UNDP/UNOPS: “Comprehensive Disabled Afghan’s Program: Integrating Disabled and Marginalised People in Afghanistan”,Journal of Mine Action, Fall 1999, vol. 3, no. 3.9Multi Indicator Cluster Survey, 2003 Report, Ministry of Education, UNICEF and CSO.10Ministry of Rural Rehabilitation and Development, Vulnerability Analysis Unit, Report on Findings from the 2003 NationalRisk and Vulnerability Assessment in Rural Afghanistan, December 2004, www.mrrd.gov.af/vau/NRVA_2003.htm#WFP. Accessed:November 2-2005.Prevalence and Typology7
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 20 and 21: A variety of subjects and fields ad
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
Page 74 and 75:
Figure 43: Distribution of Persons
Page 76 and 77:
Figure 46: Distribution of Househol
Page 78 and 79:
62 Understanding the Challenge Ahea
Page 80 and 81:
The inability tobear children is am
Page 82 and 83:
The situation is somewhat different
Page 84 and 85:
Figure 51: Distribution of Persons
Page 86 and 87:
706050• Landmine/UXO Survivors•
Page 88 and 89:
ConclusionInclusion is a major fact
Page 90 and 91:
of persons with disability 48 . Thi
Page 92 and 93:
GHOSH N., MOHIT A., MURTHY R.S. (20
Page 95:
The National Disability Survey in A
show all

Handicap International experience in Afghanistan - CBM

You also want an ePaper? Increase the reach of your titles

Delete template?

Save as template?