Handicap International experience in Afghanistan - CBM

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ConclusionInclusion is a major factor to look at when formulating recommendations for stakeholders active in thedisability field. Today, Afghanistan does not yet have disability public policies that express commitments toequalise opportunities for persons with disability. Furthermore, while in the process of being established,these policies must be defined by the persons with disability themselves. The NDSA project in general, andthis document particularly, is a tool for organisations of persons with disability, to help them find their wayagainst social and environmental barriers and their place in Afghan society. The project adopts a capabilityapproach towards disability by focusing on what individuals value doing or being in a given environment.It also highlights the social, economic and environmental barriers to equality that persons with disabilityundergo in the Afghan society.While progressis beingmade towardsemployment forpersons withdisability, manybarriers remain,especially forwomen withdisabilities andpersons living inremote rural areasRemove BarriersThe economic environment has a major impact on opportunities in terms of employment and autonomyof persons with disability. Generally barriers are related directly to the type of disability the individual has.Working, whether in an administration, a company, in the fields or outside the compound, is a significant issuefor persons with disability. This can ultimately affect their ability to gain an income, or to produce food andengage in income generating activities. Inaccessibility is due to several constraints: impairment as well aspoverty and physical inaccessibility. Other types of barriers are linked to attitudes and prejudice.Changing Social Attitudes and Beliefs Regarding DisabilityIn Afghanistan, a problem arises from the fact that disability is not perceived in the same way everywhere,and varies according to gender differences, traditional or ethnic attitudes and religious motives. Therefore,persons with disability may be more or less vulnerable in daily life and may not be subjected in the sameway to poverty. In fact, they do not constitute a homogeneous group, but various sub-groups facing differentneeds and opportunities.Gender ConcernsThe fact that in many areas of social and economic life, women are systematically in a worse situation thanmen is of great concern. The NDSA analysis clearly shows that women with disability are poorer, cannotaccess school, are in worse health conditions, do not participate to the labour market and, as a result ofstigmatization, are excluded from social participation. Better access for women and girls with disability tohealth services and to schools can be ensured by increasing the number of women staff.Access to Employment and Income: Changing PerceptionWhen asked, the first thing persons with disability seek is a job to earn their living. While progress is being madetowards employment for persons with disability, many barriers remain, especially for women with disabilitiesand persons living in remote rural areas. The labour market, dominated by the agricultural sector, provides fewopportunities for the most impaired, and especially for women if they are disabled. Yet, the practice of a paidactivity is a clincher for social recognition, thus self-esteem and independence. Nevertheless, average income ofpersons with disability is lower and the level of unemployment is higher than that for non-disabled. Even if thelevel of employment for persons with physical or sensorial disability (mainly men) and for war survivors is ashigh as for non-disabled persons, the level of income remains lower for the former. An active employment policybased, among other measures, on a general obligation of employment of a certain percentage of persons withdisability, both in public and private sectors, is a first step towards inclusion in the labour market.Access to Public Services: Health and EducationMany of the causes of impairments and injuries are preventable by increasing the level and quality ofantenatal care, improving women’s health education, improving immunisation, eliminating malnutrition and72 Understanding the Challenge Ahead
promoting awareness regarding a balanced diet and other daily practices to improve health. In brief, priorityfocus should be placed on prevention rather than cure, using a multidisciplinary approach that includes localleaders and other communication tools such as radio broadcast.Persons with disability are currently spending more for their health and using the health facilities more thannon-disabled. Nevertheless, they face more constraints and difficulties in benefiting from a better health.Ensuring access to health services is a priority. A major issue is to address barriers to access public healthservices such as distance to health facilities and cost. For people with reduced mobility, assistive devices –standardised, well-made, well-fitting, using local materials whenever possible and repairable locally – shouldbe made available countrywide. Availability of generic drugs at the lowest possible price is also a challenge.The development of vaccination programmes is another challenge. In order to follow-up with the inclusion ofpersons with disability in the health system, and particularly at the level of the BPHS, they should be trackedthrough the MoPH information management systems.The current efforts of different decision makers to send children to school are not reaching persons withdisability equally. The proportion of non-disabled children accessing public schools is almost two timeshigher than the proportion of children with disability. Another major challenge is access to school for girls,and especially girls with disability. The current deterioration of the security situation might become a stepbackward in the access to school for girls in parts of the country. An important way to strongly supportinclusive education is to make schools accessible to children with disability and change legislation in order toinclude children with all types of disability, including the most severely disabled, in schools for the compulsoryeducation period. Responsibility for the education of children with disability will be placed upon the MoEalong with a coordinating body to be created. A major issue is awareness – to convince teachers and bothfamilies of children with disability and parents of other children of the relevance of inclusive education.Because integration of children with disability into the general educational system requires planning by allparties concerned, the coordinating body will ensure effective coordination work of all stakeholders, fromconception of the law to training of teachers, awareness of community and designing of buildings.Empowerment: Decisions Taken by Persons with DisabilityPersons with disability have not yet succeeded in having their voices heard, except for war survivors whoare the only persons with disability enjoying real prestige in Afghan society due to their status as formerMujahidin. The capability approach applied to disability offers a perspective of empowering all persons withdisability by providing a framework aiming at equal entitlements for persons with disability and non-disabledpersons. The well-being and subsequent freedom of persons with disability depends on their capacity toexpress their needs and benefit from opportunities offered by a welcoming and inclusive environment. Publicpolicies must ensure their capacity to fully participate in social life.Gathering ofknowledgeon livelihood,beliefs, needsand expectationsof persons withdisability is away of fuelling anational disabilitystrategy based onsuch principles asempowerment andmainstreamingMainstreaming: Inclusion and Accountability?Gathering of knowledge on livelihood, beliefs, needs and expectations of persons with disability is a way offuelling a national disability strategy based on such principles as empowerment and mainstreaming. Thisview, which has been put forward by a number of disabled persons’ organisations, tends to look at the barriersthat exist within the social context and that prevent a person from achieving the same level of functioning asthat of a non-disabled person. In this perspective it is society that needs to be redesigned in order to take intoaccount the disabled persons’ needs. Mainstreaming persons with Disability is a progressive way of reshapingsociety in order to better include them.Coordination of Action and Actors: Towards the Institution of aCoordinating Body?The participants in the First National Landmine Victim Assistance Workshop held in Kabul between 6th and8th August 2006 at the Ministry of Foreign Affairs enthusiastically advocate the creation of an independentcoordinating body in charge of disability issues in Afghanistan with a strong representation of organisationsConclusion73
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Islamic Republic of AfghanistanUNDE
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ContentsAcknowledgementsAbbreviatio
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Figure 25 : Retention, Transition a
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AbbreviationsAFAs : AfghanisBPHS :
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PrefaceThe National Disability Surv
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IntroductionAs the process of recon
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Figure 1. Sampling Stages of NDSA1s
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A variety of subjects and fields ad
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• Beliefs and expectations of wha
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Prevalence Threshold with Regard to
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The proportion of persons with disa
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Mental disability shows a much more
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The effectiveprevalencerate of seve
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to a maximum of 37.4% unable to coo
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Table 3. Proportion of Persons with
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Table 4: Proportion of Persons with
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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
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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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