Handicap International experience in Afghanistan - CBM

The proportion of persons with disability is not very high in the earlier stages of life. This can be explainedby various reasons. It is probable that certain forms are not yet detected at an earlier age. Furthermore,bearing in mind the infant mortality rate in the country (115/1000 live births) 12 , that ranks among the worstworldwide, children with disability or those who become disabled at an early stage are more vulnerable andhave lower survival rates than non-disabled infants.More than half the persons with disability are in the Central and Western areas. This can be explained bythe presence of 2 highly populated cities in these areas, i.e., Kabul and Herat. The NDSA results also showthat the proportion of persons with disability is higher in Central, Western and Southern areas and above thenational average prevalence rate. On the other end, in the Eastern, North Eastern and North Western areas,the proportion is below the national average.More than halfthe persons withdisability arein the Centraland Westernareas. This canbe explained bythe presence of 2highly populatedcities in theseareas, i.e., Kabuland HeratIt is challenging to understand what lies behind these differences, as it is often a combination of individual,social and political factors, as a result of which, certain regions have high proportions of Internally DisplacedPersons (IDPs) who moved during various conflicts. The availability and stability of health services could alsoresult in a higher prevalence rate linked to better health care (so persons with disability have better chancesof surviving through illnesses and accidents) as well as better detection.Looking at the Typology of DisabilityIt is important to bear in mind that the results presented concern that 2.7% of the population who weredetected as having severe difficulties in the screening questionnaire. This choice has been made mainlybecause the GoA and other stakeholders are targeting on priority basis persons with severe impairments. It istherefore essential to look at the typology and the profile of this population. The typology, like the definition ofdisability, was based upon difficulties in functioning and was devised after extensive discussion with personswith disability, partners and experts working in the field.Determining Typology: The Various Sections of the Screening ToolThe following disabilities were included in the screening tool of the NDSA. All questions were focused on theability or difficulty to function in everyday life. The various sections were defined according to a wide rangeof criteria.Section A: Physical and Sensorial Difficulties• Lack part of/entire member(s) or functions of the body;• Difficulties that impede movement and mobility;• Visual impairments;• Hearing impairments;• Speech Impairments.Section B: Intellectual and Learning Difficulties• Later/slower speaking patterns compared to other members of the family;• Later/slower walking, mobility development compared to other members of the family;• Behaviour that does not correspond to the given age (child behaving younger than age).Section C: Behavioural and Psychological Difficulties• Difficulty or impossibility in expressing needs, using language that no one understands;• Difficulty or impossibility in being with people who are not familiar;• Difficulty or impossibility in keeping still/ staying in one place;12UNDP (2004), op. cit.10 Understanding the Challenge Ahead