Handicap International experience in Afghanistan - CBM

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The effectiveprevalencerate of severedisability basedon the screeningtool is situatedin the lowerestimates thatwere consideredfor Afghanistanby experts. Thisrate is close tothe previousestimates madeby differentsurveysSteps Forward:Allow Future Comparisons with Other Surveys and with Other Countries in the RegionEstablishing a few benchmarks to define disability within the Afghan context seems to be essential in orderto adequately monitor progress made in the future as well as assess how the country is doing with regard toneighbouring states in the region. A first step was taken in this direction during the UNESCAP 4th Workshopfor Improving Disability Statistics and Measurement, held in Bangkok in June 2006. The main aim of thisinitiative was to introduce the principles and requirements for collecting, producing, and disseminatingdisability statistics at the national and international levels. A first step in this direction would be delineatingthe elements that define disability in Afghanistan, in line with regional standards 15 . This would allow reliablemonitoring and inter-country comparisons.Improving Knowledge about Afghans with DisabilityThe effective prevalence rate of severe disability based on the screening tool is situated in the lower estimatesthat were considered for Afghanistan by experts. This rate is close to the previous estimates made by differentsurveys. In a country where life expectancy at birth is amongst the lowest in the world, this may signify that aproportion of Afghans with disability are more prone to disease, illness, accident or even neglect. These figuresalso suggest a lack of knowledge and awareness regarding shunned or hidden forms of disability wherestigma and discrimination make detection difficult. On the other hand, if the threshold to define disability isbased on the health set of 46 questions, then very severe disability rates 2.2% and severe disability rates10.8% of the whole Afghan population.The next step is to understand the living conditions of persons with disability, by looking more closely atthe proportion of those who benefit from health services, education, employment, income and decent livingconditions. The following sections will summarise this information according to various fields: try to bring intolight what exists and what remains to be done.15For more information please visit the website: http://www.unescap.org/stat/meet/widsm4/index.asp14 Understanding the Challenge Ahead
The Health PictureAccess, Costs, NeedsSECTION3Since the end of 2001, attempts have been made by the government to secure peace and stability, andto rehabilitate the devastated infrastructures. Despite these efforts, the national health indicators remainalarming. The maternal mortality rate is reported to be 1600 per 100,000 live births, the under-five mortalityrate is estimated at 172 per 1000 births and the infant mortality rate is 115 per 1000 births 16 . Thesestatistics are the reflection of over twenty years of on-going conflict as well as political instability.While general statistics are used to gauge the progress of the health sector in addressing the needs of thepopulation, very little is known regarding the health status of one of the most vulnerable groups of Afghans,i.e., persons with disability. Knowledge regarding the health indicators of this population is very limited, evenmore so when it comes to their access to and use of health services. The 2005 National Disability Surveyin Afghanistan is the first survey aiming to provide insight into the health status and challenges faced byAfghans with disability.The Ministry of Public Health (MoPH) has been assigned the task of addressing the health needs of theAfghan population. In 2003, this ministry established a health services delivery policy called the BasicPackage of Health Services (BPHS) which outlined seven areas of priority in: maternal and newborn health,child health and immunisation, public nutrition, communicable diseases (tuberculosis and malaria), mentalhealth, disabilities, and finally, the supply of essential drugs. They were grouped into three tiers according topriority. Due to lack of knowledge on the scope of the problems, lack of resources and insufficient capacityto integrate services, both mental health and disabilities were associated with secondary tier interventions.With the revision of the BPHS in 2004 and 2005, the provision of mental health and rehabilitative servicesfor disabled Afghans was elevated to first-tier interventions. Despite this, comprehensive development ofservice-provision activities has been slow and is in need of guidance.Types of DifficultyIn general, persons with severe disability reported a number of difficulties in their ability:• To satisfy their daily self-care needs without any assistance or equipment (questions asked to childrenabove 8 years of age and adults);• To perform household chores (questions not asked to adult men);• To carry out tasks outside the house/in the field.While generalstatistics areused to gaugethe progress ofthe health sectorin addressingthe needs of thepopulation, verylittle is knownregarding thehealth status ofone of the mostvulnerable groupsof Afghans, i.e.,persons withdisabilityThis series of three major fields of activities gives a good overview of difficulties faced in everyday life byseverely disabled persons. Looking at the ability to function in everyday life also helps understand what theimpact of disability might mean to a household as a unit. The fact that a person with disability may requireassistance in a variety of tasks implies the need for caretakers within the household and/or the community.A large number of people rely on the other members of their family to fulfil their basic daily needs.Daily Self-Care NeedsOur results show that a majority of persons with disability need some kind of assistance in everyday functioning.This proportion can range from a minimum of 12.9% for going to the toilet and 13.4% for getting dressed,16UNDP (2004) op. cit.
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 22 and 23: • Beliefs and expectations of wha
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 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 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 76 and 77: Figure 46: Distribution of Househol
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
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Handicap International experience in Afghanistan - CBM

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