Children with Disabilities in South AfricaA Situation Analysis 2001-2011

George Laryea-AdjeiUNICEF

March 2014

Background

• Overall, there is a dearth of comprehensive research on childhood disability in South Africa.

• There are substantial information gaps on prevalence rates, coverage and impact of available services, as well as policy constraints in increasing the coverage and quality of services for children with disabilities.

• This Situation Analysis seeks to fill these knowledge gaps.

Key questions

• What is the extent of disability among children in South Africa?

• What is the extent of inequities and unfulfilled rights of children with disabilities?

• What factors have contributed to limited action being taken by the state and civil society?

• What are strategic opportunities for action?

Framework: HRA+ICFInternational Classification of Functioning, Disability and Health (ICF)

HEALTH CONDITIONS ASSOCIATED WITH CHILD DISABILITY = umbrella term for diseases, disorders and injuries

THREE DIMENSIONS OF CHILD DISABILITY

IMPAIRMENTS = problems in body function or structure such as a significant deviation or loss.

ACTIVITY LIMITATIONS = difficulties a child may have in executing tasks or actions.

PARTICIPATION RESTRICTIONS = problems a child may experience in involvement in life situations (compared to that which is expected of a child without disability).

CONTEXTUAL FACTORS = both external environmental factors (for example, social attitudes, architectural characteristics, legal and social structures, etc.) and internal personal factors (gender, age, coping styles, social

background, etc.) influence how disability is experienced by the individual.

Situation Analysis of Children with Disabilities in South Africa

1) Situation of children with disabilities + causes of disabilities 2) Response from government at all levels, civil society, families, etc.

Collation and analysis of data State obligations under UN Conventions Institutional analysis

Quantitative Qualitative National legislative, Desk reviewSecondary data analysis of: Desk review policy and practice environment Stakeholder consultations - Prevalence, types, causes focus-group discussions Definition of responsibilitiesCompare child services and outcomes Stakeholder consltations Cooordination at all levels -Between-group comparison Capacity assessments -Within-group comparison Programme budgets?

Causes of inadequate scope

and quality of response

The policy landscape

• South Africa has ratified international treaties, including the UNCRC (1995), ACRWC/African Charter (2002) , UNCRPD (2007)

• Integrated National Disability Strategy (1997); The Children’s Act 38 (2005); Admission Policy for Ordinary Public Schools; the White Paper on Special Needs Education; free health care for persons with disabilities; the Mental Health Act; the Social Assistance Act; and the Disability Framework for Local Government 2009-2014 ; Integrated National Strategy on Support Services to Children with Disabilities 2009

Country context of inequality• Backdrop of one of the highest gini-coefficient’s in the world -

Overall, particular groups of children – very young children, children in poverty, many African children, children with disabilities, and children living in the former homelands and informal settlements – appear to experience multiple deprivations” in the unequal South African Society

• Disability overall, but particularly in childhood, deepens this inequality. Not only do children with disabilities experience the inequality similar to their peers, it is further compounded by the fact that they have a disability; thus a double jeopardy

• Affecting children with disabilities, including large inequities in accessing services and child development outcomes

• Compared to their non-disabled peers, children with disabilities are less likely to attend school; less likely to have access to adequate housing, water and sanitation; more likely to suffer from illnesses and poor health; and more likely to be deprived of parental care and to experience abuse

Percentage of children reported to have any serious disability by district

Capacity for early detection: parental education

By orphan status

by type of disability

 Type of disability Number of children affected

Prevalence (%) in child population

Distribution (%) among children with 

disabilitiesSight (blind/severe visual limitation) 100,345 0.6 23.0

Hearing (deaf, profoundly hard of hearing) 92,549 0.5 21.2

Intellectual (serious difficulties in learning) 68,550 0.4 15.7

Physical (e.g. needs wheelchair, crutches or prosthesis)

64,911 0.4 14.9

Multiple (combination of two or more) 44,790 0.3 10.3

Emotional (behavioural, psychological) 42,830 0.2 9.8

Communication (speech impairment) 22,148 0.1 5.1

At least one disability 436,123 2.5 100.0

Risk factors

• factors occurring before birth (during pregnancy, antenatal, prenatal)

• factors at birth (neonatal), after birth, infancy

• Early childhood• Child injury• Malnutrition• Environmental 

Adequacy of measures to prevent impairments and activity limitations

• Early detection and intervention measures in the health system

• Detection of disability in the education system

children attending an educational institution by age and disability status, 2007

Adequacy of measures to decrease the impact of disability and enhance social participation

• Care Dependency Grant• Assistive devices• Rehabilitation• General health care• ECD• Inclusive education

Number children on the Care dependency grant

Number of registered physiotherapists working in the public sector (2007-2011)

  Registered with 

HPCSA

Working in the public sector

Year Total Total %

2007 5 059 850 17

2008 5 314 903 17

2009 5 582 946 17

2010 5 777 1 009 17

2011 5 937 1 057 18

Number of registered occupational therapists working in the public sector (2007-2011)

  Registered with 

HPCSA

Working in the public sector

Year Total Total %

2007 3 015 736 24

2008 3 174 785 25

2009 3 325 806 24

2010 3 508 838 24

2011 3 629 940 26

Constrained access

• Health: district hospitals were less accessible to people with disabilities than tertiary hospitals

• Early childhood development • School enrolment and dropout: 2010 - 37

percent of disabled youth between 16 and 18 years of age had dropped out of school, compared to 14 percent of youth without disability.

• Social grants: Access to CDG continues to grow, with a 30 percent increase from 2005 to 2011.

• Significant gaps remain in access to assistive devices, rehabilitation personnel, inclusive education, friendly built environment

Underlying causes of limited action by the state and society

• Attitudes and approaches by society and officials• Laws and policies - Lack of alignment of laws and

policies to specific plans• Plans and budgets – resource adequaucy, funding

NPOs• Issues around ‘mainstreaming’• Human resources - expertise for assessment, early

identification and intervention• Planning standards/ access to built environment,

assessment tools for social model• Information systems• Etc.

• The numerous policies in place which are intended to fulfil government’s constitutional and legal obligations towards children with disabilities have not been consistently linked to national and provincial planning processes (DSD, DWCPD/UNICEF, 2012:14). This ‘inadequate alignment of policies to plans of Departments continues to undermine the pace of service provision’

Opportunities for action

• NHI and PHC reengineering• Early identification and intervention• Care dependency grant• Rehabilitation• Inclusive education• Scalable projects

how opportunities could be utilised

• Disability Act and strengthening of existing legislation

• Conditional grants• Service delivery environment – community

based support, coordination• Twin-track approach