Intersectoral coordination in the provision of care for specially abled persons

Dr. Prashant Ghodam

Moderator: Dr. Chetna Maliye

Framework

• Introduction• Magnitude• Disabled population in India, Maharashtra & Wardha• Health and Socioeconomic outcomes• Rights of Persons with Disabilities • Legislations• Intersectoral collaboration• Convergence of various Ministries• Government Initiatives• Challenges / Scope • References

Introduction

• What is Disability? • “is an umbrella term, covering impairments, activity limitations, and

participation restrictions. • Impairment is a problem in body function or structure.• Activity limitation is a difficulty encountered by an individual in

executing a task or action• Participation restriction is a problem experienced by an individual in

involvement in life situations. • Thus disability is a complex phenomenon, reflecting an interaction

between features of a person’s body and features of the society in which he or she lives.“ (WHO)

• ‘A person with restrictions or lack of abilities to perform an activity in the manner or within the range considered normal for a human being’.(NSS)

Introduction

• Disability: A restriction or inability to perform an activity in the manner or within the range considered normal for a human being, mostly resulting from impairment.

• Impairment: Any temporary or permanent loss or abnormality of a body structure or function, whether physiological or psychological. An impairment is a disturbance affecting functions that are essentially mental (memory, consciousness) or sensory, internal organs (heart, kidney), the head, the trunk or the limbs.

• Handicap: This is the result of an impairment or disability that limits or prevents the fulfilment of one or several roles regarded as normal, depending on age, sex and social and cultural factors. (The International classification of impairments, disabilities and handicaps )

Magnitude • About 15% of the world's population have a disability Severe

enough that it limits their participation in family, Community and political life.

• Eighty percent of those people live in low and middle income countries, where often access to basic health and social services is limited.

• In India PWD comprise between 5 and 8 % of the Indian population.

• Rates of disability are increasing due to population ageing and increases in chronic health conditions, among other causes.

• People with disabilities have less access to health care services and therefore experience unmet health care needs.

Disabled Population in India, Maharashtra & Wardha: 2011

Proportion of Disabled PopulationIndia and States/UTs

Disabled Population by Sex and Residence India: 2011

Residence Males Females Total

Rural 10,408,168 (2.43)

8,223,753 (2.03 % )

18,631,921 (2.24 % )

Urban 4,578,034 (2.34 % )

3,600,602 (1.98 %)

8,178,636 (2.17 %)

Total 14,986,202 (2.41 % )

11,824,355 (2.01 %)

26,810,557 (2.21%)

Disabled population by type, IndiaTypes Rural Urban Total

Seeing 3502590 1529873 5032463

Hearing 3391821 1679186 5071007

Speech 1303783 694752 1998535

Movement 4035519 1401085 5436604

Mental Retardation 1025560 480064 1505624

Mental Illness 495826 227000 722826

Any other 3292529 1634482 4927011

Multiple Disability 1584293 532194 2116487

Disabled Population by Sex and Residence Maharashtra: 2011

Residence Males Females Total

Rural 950781 715354 1666135

Urban 741504 555753 1297257

Total 1692285 1271107

2963392

Disabled population by type, Maharashtra

Types Rural Urban Total

Seeing 321266 252786 5032463

Hearing 237739 235532 473271

Speech 240835 232775 473610

Movement 363353 185065 548418

Mental Retardation 92318 67891 160209

Mental Illness 33972 24781 58753

Any other 270742 239994 510736

Multiple Disability 105910 58433 164343

Disabled Population by Sex and Residence Wardha: 2011

Residence Males Females Total

Rural 12277 9100 21377

Urban 4612 3252 7864

Total 16889 12352 29241

Disabled population by Age & Sex : Wardha

0 to 4

5 to 9

10 to 19

20 to 29

30 to 39

40 to 49

50 to 59

60 to 69

70 to 79

80 to 89

90 + ANS0

500

1000

1500

2000

2500

Male

MaleFemale

Disabled population by type, Wardha

Types Rural Urban Total

Seeing 5008 1674 6682

Hearing 3094 985 4079

Speech 999 402 1401

Movement 5737 2381 8118

Mental Retardation 1307 718 2025

Mental Illness 1000 318 1318

Any other 2029 780 2809

Multiple Disability 2203 606 2809

Health and Socioeconomic outcomes

People with disabilities face widespread barriers in accessing services, such as those for health care (including rehabilitation), education, transport and employment. Poorer health than the general population. Higher rates of poverty than people without disabilities. Low educational achievement. Reduced economic participation. Increased dependency and

restricted participation.

Health and Socioeconomic outcomes

Secondary conditions: Pressure ulcers, UTI, osteoporosis and pain.

Comorbid conditions: Prevalence of diabetes in people with schizophrenia is around 15% compared to a rate of 23% for the general population.

Age related conditions: People with developmental disabilities show signs of premature ageing in their 40s and 50s.

Health risk behaviours: PWD have higher rates of risky behaviours such as smoking, poor diet and physical inactivity.

Premature death: It is found that people with mental health disorders and intellectual impairments had a lower life expectancy.

Rights of Persons with Disabilities

o India as a signatory of UN Convention on the Rights of Persons with Disabilities

Right to Life and Personal Liberty Right to Live in the Community Right to Integrity Protection from torture or cruel, inhuman or degrading treatment or punishment Protection from Abuse, Violence and Exploitation Protection and Safety of Persons with Disabilities in Situations of Risk Right to Home and Family Reproductive Rights of Persons with Disabilities Freedom of Speech Right to Political Participation Access to Justice

Legislations The Persons with Disabilities (Equal Opportunities,

Protection of Rights and Full Participation) Act, 1995 • A person with disability means ‘a person suffering from not

less than forty percent of any disability as certified by a medical authority.

• It lays down specific measures for the development of services and programmes for equalising opportunities for the enjoyment of right to education, work, housing, mobility and public assistance in case of severe disability and unemployment.

• It include blindness, low vision, hearing impairment, locomotor disability or cerebral palsy, mental retardation, mental illness and persons cured of leprosy.

Legislations National Trust for Welfare of Persons with Autism, Cerebral

Palsy, Mental Retardation and Multiple Disabilities Act, 1999. • To execute the mandated responsibilities, a Central Co-

ordination Committee and State Co-ordination Committees representing major development ministries,

• Members of Parliament and disability NGOs and having a woman with disability as a member have been envisaged in a multi-sector model.

• The institution of Chief Commissioner in the Centre and Commissioner for Persons with Disabilities in States has been proposed. Their mandate is to redress individual grievances, provide safeguards to the rights of PWD, monitor implementation of disability related laws, rules and regulations, and oversee utilisation of budget.

Intersectoral collaboration

• Intersectoral Action (Intersectoral collaboration) : Activities and strategies involving several components of the body politic (e.g., the health sector, the education sector, the housing sector) that, working together, can enhance health conditions more effectively than when working independently of one another. (JM Last . A Dictionary of Public Health. Oxford, UK: Oxford University Press, 2007.)

Intersectoral colla….• Intersectoral collaboration and interagency

cooperation is the necessary for mainstreaming of disability issues into the major development agenda.

• In the Asian and Pacific region, experiences in pursuance of the fulfilment of targets in many policy areas under the Agenda for Action during the Asian and Pacific Decade of Disabled Persons, have clearly proven such necessary.

Intersectoral colla….

• Whole United Nations system and intergovernmental agencies as well as many non-governmental organizations are engaged to further strengthen interagency cooperation, including education, health, labour, telecommunication, economic and social development and other fields, with a view to achieving an inclusive, barrier-free and rights-based society for persons with disabilities in Asia and the Pacific in the twenty-first century.

Convergence of various Ministries

• Ministry of Social Justice & Empowerment • Ministry of Health and Family Welfare• Ministry of Women and Child Development• Representative of the Ministry of Human Resource Development• Ministry of Housing and Urban Poverty Alleviation• Ministry of Communications and Information Technology• Ministry of Civil Aviatation• Ministry of Rural Development• Ministry of Urban Development• Ministry of Finance• Ministry of Defence, Govt of India• Ministry of Youth Affairs & Sports

Government Initiatives Ministry of Health and Family Welfareo National Leprosy Eradication Programme Involvement of NGO ILEP Agencies WHO Supporto National Programme for Control of Blindness Private Practitioners NGOso National Iodine Deficiency Disorders Control Programme Health Education and Publicity.(Information, Education and Communication, IEC)o National Mental Health Programme (NMPH) Barriers to Implementation of the Programme: Negative attitude of general

practitioners, primary care physicians and other specialists. NGOs/Voluntary Organizations do not find this field attractive

Challenges/ Scope

o More collaboration among the GOs, NGOs,

and the PWDs themselves should be pursued. o Responses to the needs of the sector with disability, to maximize the funds

and resources. o Need of more intensive advocacy programs to raise the levels of

awareness and knowledge about the rights of PWDs & recognize the importance of the role of partnerships between private and government sectors for the empowerment of PWDs.

o Technical assistance to local government to continually improve management capabilities, improving the quality of services and thereby ensuring program sustainability at the local level.

o More research is needed, not just about the lives of people with disabilities, but also about social barriers, and how these can be overcome.

References1. World Health Organization and World Bank. World report on disability. Geneva, World

Health Organization, 2011.

2. The Report on Disability – Census of India 2011 by Office of Registrar General & Census Commissioner, Government of India.

3. People with Disability in India: From Commitments to Outcomes by Human Development Unit, South Asia Region, The World Bank.

4. The Draft on Rights of persons with disabilities bill 2012, Government of India, Ministry of Social Justice & Empowerment, Department of Disability Affairs September, 2012

5. Disability at a Glance 2008 & 2009 by UNESCAP.

6. WHO, Disability and health, fact sheet 352; Available from: http://www.who.int/mediacentre/factsheets/fs352/en/

7. Annual Report (2010) of Ministry of Social Justice & Empowerment, Government of India.

8. National Policy for Persons with Disabilities 2006, Ministry of Social Justice and Empowerment, Government of India; No.3-1/1993-DD.III.

9. WHO, UNESCO, ILO. International Disability and Development Consortium. Community-based rehabilitation: CBR guidelines. Geneva, World Health Organization, 2010.

10. Kumar S.G., Roy G, Kar S.S, Disability and Rehabilitation Services in India: Issues and Challenges, J Family Med Prim Care. 2012 Jan-Jun; 1(1): 69–73.

“Science may have found a cure for most evils; but it has found no remedy for the worst of them all

-the apathy of human beings." - Helen Keller

Thank you