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1、 Strategy for Mainstreaming DisabilityHuman Development DepartmentSouth Asia RegionI.IntroductionDisability is a significant obstacle in reducing poverty. The two-way link between poverty and disability creates a vicious circle. Poor people are more at risk of acquiring a disability because of lack
2、of access to good nutrition, health care, sanitation, as well as safe living and working conditions. Once this occurs, people face barriers to the education, employment, and public services that could help them escape poverty. These barriers include intense stigma, as well as barriers related to inf
3、rastructure, service delivery and program design. There is a growing body of evidence on disability as an important development issue. Its links to poverty, as a barrier to achieving the MDGs, and influence on vulnerability and social/economic/political exclusion are being better documented in numer
4、ous small and large scale international studies. In South Asia alone, there are an estimated 150 million people living with disabilities, affecting up to 16 percent of households in some South Asian countries. Most countries have national acts and/or policies in place regarding Persons with Disabili
5、ties (See Annex I), yet implementation is lagging, budgets to support them are inadequate, and enforcement of laws and employment quotas is close to nonexistent. Does the Bank have a comparative advantage or mandate to work in the area of disability? Despite the paucity of accurate or consistent inf
6、ormation on the subject, the team can make the following observations: Ignoring disability frustrates the achievement of many of the outcomes of our countries assistance strategies. For example, a significant number of dropouts in the early years of school are likely due to mild, undetected disabili
7、ties which could be easily accommodated at little or no cost. Health indicators of infant mortality and morbidity, and maternal health could improve more quickly with attention to disability prevention. If most developing countries actually have a 10-15 percent prevalence rate of disability as estim
8、ated by WHO and the Bank, there is a cost to having that population unable to fully participate in social and economic activity. On the contrary, there is a higher cost to society for their dependency, the services they might require, and potential burden on their family members if their impairments
9、 get worse. People with mild to moderate disabilities could improve their productivity with low cost early interventions, education, access to services, eliminating barriers of stigma, vocational training and use of infrastructure. A one percent investment in project cost to make infrastructure acce
10、ssible at the design stage could save significantly over expensive retrofitting later.Without addressing disability, countries in South Asia cannot hope to achieve the MDGs in education, health, poverty or gender. For people with disabilities, poverty is cyclical and multidimensional, characterized
11、by: Material deprivation (low consumption, poor housing) Low human development (lack of education and access to health services) Lack of voice and ability to influence decisions that affect their lives Acute vulnerability to adverse shocks (illness, economic crises, natural disasters, conflict)This
12、strategy seeks to identify the issues confronting persons with disabilities (PWD) and their families, as well as the economic and social impact of excluding PWD from full participation in society. It will offer some solutions where the Bank could begin to engage more fully in the dialogue and work n
13、eeded to address these issues.II.Proposed Strategy and ProgramThe strategy for the Banks work on disability focuses on three key areas: mainstreaming disability into our operations, increasing our knowledge base so as to inform policy and understand the impact of disability on development, and raisi
14、ng awareness through outreach and support to government and civil societys efforts. It will be implemented by: Integrating disability into the Banks existing analytical and operational work and rather than embarking on a series of stand-alone projects. While the latter is not ruled out, our view is
15、that mainstreaming disability is the most effective method for improving the lives of disabled through our work. Primarily focusing on two countries: India and Pakistan, with the objective of demonstrating successful, deeper impact where there is ownership and dialogue with the country and CMU. Supp
16、orting task teams in other countries through cross-support where there is a clear mandate, e.g.: Gemi Diriya in Sri Lanka and other CDD programs, and work to mitigate risk in conflict areas and in disaster situations. Criteria for engagement in either a country or a specific program should remain: (
17、i) ownership of the Bank and respective country with acknowledging the importance or work in the area of disability, and (ii) building momentum on existing work.Specifically, the key activities in which we propose to engage in disability work over the next two years include: A. Operationalizing Disa
18、bility Mainstreaming Prevention and InclusionIn low income countries, in particular, preventive measures are the most cost effective means of reducing disability. However, cost effective means of improving the lives of disabled are also important for integrating disabled individuals into socio-econo
19、mic life. Given the inter-sectoral nature of disability, these programs will need to be mainstreamed in our different sectors, through disability team members participating in project preparation and supervision in the coming FY. We also propose that our disability coordinator review projects in the
20、se countries at the CN stage in both focus countries to advocate for inclusion of disability, where it is feasible.(1) Prevention: Three key preventive programs which we would proposed to be mainstreamed in our health, education and transport projects include: Early detection programs/ focus on chil
21、d nutrition (HNP-ICDS India) School screening for impairments and disabilities (Early Childhood Education India/Education, Pakistan) Traffic and Road safety Projects (Infrastructure, India and/or Pakistan)(2) Inclusion: Using cost effective ways of including disabled into social services: Design and
22、 implementation of an inclusive education pilot which could later be scaled up, integrating disability issues into DPCs (Pakistan) Develop an inclusive approach to community based health and rehabilitation services as part of our ongoing operations (RCH, India (assuming it goes through), and Communi
23、ty Based Rehabilitation (Health/Social Welfare Pakistan) Inclusive social protection (safety nets and social care services for disabled (Pak.SP). Access and empowerment of disabled through CDD programs (India-AP, Gemi Diriya, SL) Accessibility of infrastructure and all public buildings/spaces (all i
24、nfrastructure projects in India and Pakistan)B. . AAA: Increasing Knowledge and Improving Data on DisabilityAs noted above, the lack of knowledge about or agreed definition of disability hinders awareness about disability issues and impedes policy development and implementation. The main focus of th
25、is work would be to improve our data and information base on the incidence and type of disability. This involves the following key activities: Region-wide, country based surveys. Working with governments/agencies statistics and household survey practitioners to improve and integrate disability in da
26、ta collection, and building their capacity for measuring disability. Phase I would conduct a regional workshop with 2-3 key people from each country to (i) determine what information would be needed to inform policy and program development, (ii) agree on a definition of disability; (iii) develop que
27、stionnaires for piloting in their respective countries, and (iv) share lessons from other countries of what has and has not worked. Phase II would have the group reconvene after the Bank/Trust Funded pilot of the questionnaire to develop a plan for scaling up. Conduct a review of existing surveys an
28、d census questionnaires and associated analyses. One more flagship country study on disability similar to the one on India in Pakistan. Smaller qualitative studies as demanded by the dialogue and gaps in our information. Develop a training program for operational staff on disability in projects, tra
29、in relevant staff in its use.C. Awareness and OutreachThere has been a critical shift away from addressing disability as either a medical condition or charity towards a social, inclusive model of disability. The model seeks to address limitations on PWD in participation in the life of their society
30、which are created by environmental factors (accessibility, attitudes of others), individual factors (gender, age, education) and the impairment(s) which the individual has. The Bank can ensure the full participation of PWD in its outreach and support to policy development by continuing to engage in:
31、 Outreach and promotion through continued support to high visibility national conferences and seminars, such as the National Consultation on the Plan of Action for the Policy for Persons with Disabilities Encourage inclusion of PWD and Disabled Persons Organizations (DPO) in all these activities and
32、 provide continued support through our various small grant programs. Another Development Marketplace focused on disability would bring DPOs into the mainstream. Another Development Marketplace focused on disability would bring DPOs into the mainstream. Inclusion of PWD in CAS/other consultations.III
33、. Proposed Program and Related BudgetThe existing SAR work program already contains specified funds for activities related to disability: (i) the Pakistan Earthquake Disability Project, (ii) preparation of a JSDF for an inclusive education pilot in Pakistan, (iii) completion of the Pakistan Safety N
34、et study, (iv) dissemination of the India disability study, and (v) inclusive education in the Sri Lanka education program. Additional funding is requested for the following broad categories:SAR Disability Work Plan/Budget: Regional Special Initiative Funds OnlyActivitySource of BudgetFY 06000(actua
35、l)FY 07000FY 08000FY 09000Total Regional Initiative BudgetFY 06-09Operationalizing DisabilitySupport to operations, including PRSCs, etection programs, inclusive education, road safety, CDD projects, etcCountry Budgets and Trust Funds135135135ESW and AAARegional capacity building to improve and inte
36、grate disability into data collection, training of relevant staff, etc.Other country study, policy notes, demand driven qualitative studiesRegional InitiativeCountry Budgets and OSF1562.5142.562.5142.52575165Outreach and AwarenessDialogue with governments, conferences, seminars, dissemination, small
37、 grants, other outreach programsCountry Budgets and OSF110110110SAR disability team (2 x 1/2 Staff and 1 JPA)Regional InitiativeCountry Budgets3552.5112.552.5112.515155TOTAL5011511540320IV. Background: Lessons on Disability in South Asia What emerged from our reviewInternational evidence: Although t
38、here is still no agreed definition of disability, it is widely recognized that the national census data across the region narrowly defines disability in its more severe forms, thus grossly underestimating its prevalence as well as its social and economic impact. As a result, what social safety nets
39、and targeted interventions exist in South Asian countries seldom have the desired impact on improving the lives of persons with disabilities in greatest need. Furthermore, some cost effective interventions which could prevent minor impairments from becoming disabilities particularly in the early yea
40、rs of life are weak or not undertaken at all.The World Bank and UN often cite a disability prevalence rate of about 10 percent, but quality data on disability does not generally exist for developing countries. Within developed societies, the prevalence rate is known to vary from 8 percent to over 20
41、 percent. This variance is a function of what types of disabilities are included both in kind and degree. Many developing countries report very low rates of disability, often 1-3 percent. These low prevalence rates usually result from methodological weaknesses and different definitions in data colle
42、ction. Recently, a few countries have adopted an approach to disability measurement based on the WHOs International Classification of Functioning, Disability, and Health (ICF), and have thus started recording prevalence rates more in line with developed countries. For example, the 1991 Brazilian cen
43、sus reported only a 1-2 percent disability rate, but the 2001 census, using the improved approach, recorded a 14.5 percent disability rate. Similar jumps in the measured rate of disability have occurred in Turkey (12.3 percent) and Nicaragua (10.1 percent).Cross-regional Prevalence Rates of Disabili
44、tyThe nature of disability and its extent can also vary across countries, depending on the main causes of disability. A study being presently undertaken by the World Bank finds that about 20 percent of the population of Bosnia is suffering from depression. Similar rates may apply in other post-confl
45、ict countries such as Afghanistan and Sri Lanka. South Asia Evidence: In South Asia, prevalence rates are estimated by official surveys and census results to be quite low precisely because of the definition and measurement reasons mentioned above. Nonetheless, analysis of existing government data re
46、veals a few critical facts about the social and economic impact of disability on PWD and their families. South Asia Prevalence of Disability: Census Data vs. Special Surveys InstrumentAfghanistan Bangladesh India PakistanSri LankaCensus/HH Survey2.71.62.22.51.6Special Surveyn/a13.36.8n/a4.0Source: D
47、raft National Disability Survey in Afghanistan; Bangladesh: GOB Survey 1998 and Action Aid five locations surveys 1997; India: 2002 census, various on specials; Pakistan: 1998 census; Sri Lanka: 2001 census, UnicefCauses of Disability in South Asia: Prevalence rates diverge significantly between cen
48、sus data and special surveys where the enumerators have been trained to collect specific kinds of data. Looking at the causes of disability, there appears to be a definite trend across Asia. The recently completed India report notes that in India, China and other Asia/Pacific countries are all in the midst of a disability transition of the causes, but that the pac
