Disability and Development

- A practical approach to inclusion in India

CONTENTS

Introduction

Chapter I The Context

Disability and Handicap....................................................................................................... 1Disability and Poverty.......................................................................................................... 4Disability as a Cross cutting Issue....................................................................................... 6Disability and Gender.......................................................................................................... 7Disability and Vulnerability................................................................................................... 8Disability and Health............................................................................................................10Disability and Education...................................................................................................... 12Disability and Water and Sanitation Services...................................................................... 13Disability and Economy....................................................................................................... 14Disability and Governance...................................................................................................15

Chapter II The Concept

The Tradition: Disability Rehabilitation.................................................................................17 A Comprehensive Approach: Disability in a Social and Rights Based Context .................19The Way Forward: Disability in Development ..................................................................... 21A Human Rights Focus........................................................................................................ 22Mainstreaming Disability......................................................................................................23

Chapter IIIThe Approach

The Vision............................................................................................................................ 24Principles of the Orientation and Sensitisation Training Module......................................... 25Key Considerations when Planning the Orientation Module............................................... 26Designing the Training Module............................................................................................27The module ......................................................................................................................... 28

Chapter IVThe Experience

Comprehensive Community Based Rehabilitation.............................................................. 47Inclusive Education..............................................................................................................48Inclusive Employment..........................................................................................................48Inclusive Income Generating Activities............................................................................... 49Inclusive Decision Making and Inclusive Organisations..................................................... 49The Conclusion.................................................................................................................... 50

Annexure : Disability and Development: case studies............................................................51References : Where to find more information.............................................................................56

Copyright © Handicap International

Bringing out this publication has been an excellent exercise of team effort and cooperation. In fact the “Disability and Development – a practical approach to inclusion in India” module has been successful because of the active involvement and commitment of all stakeholders and partners especially people with disabilities and their organisations.

The booklet has been written in a time span of over four years on the basis of experiences of executing the training module with different partner organisations facilitated by the Handicap International – India, Gujarat team. Thus various people in individual capacity and/or as representative from various partner organisations have contributed to give it a final shape. We take this opportunity to acknowledge contribution of each of them.

Special thanks go to the following individuals and their respective teams for outstanding support and contributions:

Lalit Baweja for writing the first draft of the text of the book with so much enthusiasm and commitment.

Alana Officer, Country Director of Handicap International, 2001-2005, India for her valuable inputs and for contributing to the foreword.

Binoy Acharya and Geeta Sharma of UNNATI for providing valuable inputs and also for the foreword.

Snehal Soneji then Program Manager, Handicap International - Gujarat for his contribution and support.

Special appreciation needs to be mentioned for the following members of the Handicap International – India team who have contributed in various capacities such as research, editing, coordinating and the many other tasks that are needed to put a publication together:

Alain Coutand, Country DirectorNalini Paul, Advocacy & Communication Manager D Rama Rao, Program AssistantHetal Thaker, Communications Coordinator Narinderjit Kaur Sethi, Assistant Coordinator, Inclusion and Rights

This publication would not have been complete without the specific and pertinent technical inputs from the Handicap International - South Asia Regional Coordinator (HI – SARC) team specially Sally Baker – Regional Coordinator and Satish Mishra, Deputy Regional Disability Coordinator.

Special recognition is extended to Archana Shrivastava, Coordinator – Inclusion and Rights for taking this document through right from the time the module was developed and book was conceptualized.

We thank one and all !

ACKNOWLEDGEMENTS

FOREWORD

Handicap International has been significantly involved in bringing disability issues to the development sector and to civil society organisations. It has been able to move 'disability issues' beyond the traditional realm of 'welfare and rehabilitation' to recognizing it as a development and rights issue. It has contributed through providing analytical insights and practical guidance to citizens, civil society organisations, government and corporate bodies for meaningful engagement for inclusion of people with disabilities. UNNATI is proud to be associated with this process.

“Disability and Development – a practical approach to inclusion in India” is an approach paper that focuses on promoting conceptual clarity on disability and how, as a cross-cutting issue, it can be interwoven in the development process. It also highlights links between disability and other sectors. In the development sector, disability issues are not yet accorded importance. The paper aims primarily to help development workers understand disability as a rights issue and take measures to include these issues in development discourse and action.

The second part of this paper includes a module containing session outlines and suggested activities for orientation and sensitization on disability and development. The activities mentioned have been tried and tested and trainers may use these as tools for conducting orientation programmes on 'disability and development'. This is only a beginning. My humble submission is that trainers may use this manual to initiate exercises, even if they are not technically competent to facilitate the activities detailed. As more people use it, clarity will emerge on issues, concepts and activities that can be used for sensitizing people. I hope that this will serve to motivate people to include disability issues in whatever area they are working in.

Through its association with Handicap International, UNNATI has been able to include these issues in its ongoing programmes and has found it extremely meaningful and useful.

Binoy AcharyaExecutive DirectorUNNATI, GujaratAhmedabad

Disability is increasingly taking its rightful place on the human rights agenda. It is crucial for individuals and organisations to learn how they can adapt themselves and their work to create a society based on the concept of human rights, including the right to development.

This paper provides a general overview of disability within the development context. It provides a practical training outline with examples of how development organisations can be engaged into action towards an inclusive and rights-based society for persons with disabilities. It is hoped that this paper will provide an impetus for a broad range of stakeholders working in education, employment, human rights, social development, advancement of women, children etc to incorporate disability issues as substantive concerns in their ongoing actions.

This paper is an outcome of the commitment, work and shared learning of many disability and development organisations notably Blind People's Association, Handicap International and UNNATI – organisation for development education and their thirteen partners in Gujarat who worked with disabled people so that they could etch out their place in the mainstream development process.

Alana OfficerCountry Director-2001-2005Handicap International –IndiaNew Delhi

FOREWORD

Many quality documents and reports have been written on inclusive practices and on the different ways to integrate a disability perspective into mainstream development programmes. “Disability and Development – a practical approach to inclusion in India” based on four years of field experience, tries to add a pragmatic and new angle to give concrete and practical recommendations to the readers. Handicap International India and its partners developed a full set of training modules and tools with the objective of providing to all interested organisations a simple and replicable methodology to contribute, towards making development more inclusive. Yes, it is an ambitious goal. Yes, there is a long way before reaching it. But, this document is also a very concrete testimony that, together, with the will to change, people with disabilities and their families can be full participants and equal beneficiaries of the development process in India.

Alain CoutandCountry DirectorHandicap International – IndiaNew Delhi

GLOSSARY

ARG Access Resource Group

ASAG Ahmedabad Study Action Group

CBR Community Based Rehabilitation

CWD(s) Child(ren) with Disability(ies)

DAG Disability Advocacy Group

DoHFW Department of Health and Family Welfare

EC European Commission

GDP Gross Domestic Product

GO Government Organisation

GoI Government of India

GoG Government of Gujarat

GVST Gram Vikas Seva Trust

ICF International Classification of Function

ILO International Labour Organisation

INGO International Non-Government Organisation

KCRC Kutch Comprehensive Rehabilitation Centre

MSJ&E Ministry of Social Justice and Empowerment

National Trust Act, 1999 National Trust for Welfare of Persons with Autism

Cerebral Palsy, Mental Retardation and Multiple

Disabilities Act, 1999

NGO Non-Government Organisation

NSSO National Sample Survey Organisation

SHG Self Help Group

PHC Primary Health Centre

PWD(s) Person(s) with Disability(ies)

PWD Act, 1995 Persons with Disabilities (Equal Opportunities,

Protection of Rights and Full Participation) Act 1995

RBA Rights Based Approach

SCF Save the Children Fund

STD Subscriber Trunk Dialling

SYVM Shree Yuva Viklang Mandal

UNCRC United Nations Convention on the Rights of the Child

UNCRPD United Nations Convention on the Rights of Person

with Disabilities

UNESCAP United Nations Economic and Social Commission for

Asia and the Pacific

UNUDHR United Nations Universal Declaration of Human

Rights, 1948

WWD(s) Woman(en) with Disability(ies)

WHO World Health Organisation

The following organisations / individuals have been part of the Disability and Development training. This broad spectrum shows that this module/tool can be adapted to the needs of different stakeholders.

• People with disabilities (100 representatives from all the districts of Gujarat)• Family of children and people with disabilities• Health Workers of Public Health project districts in Gujarat• Gram Preraks and Staff of SETU – a local organisation• Government functionaries at local and district level, panchayat, etc.• Grass root functionaries• Disabled People Organisations (SYVM of Kachchh)• Medical Officers• Butterflies (an NGO working on child rights)• Community Development Organisations (Prayas, Yusuf Mehroli Centre, BSC and 13 partner

organisations of UNNATI)• Disability Organisations (KCRC and Navchetan)• Rehabilitation Professionals• Schools- teachers, students and parents of children with and without disability• Self Help Group leaders• UNNATI - a development organisation• Save the Children Fund – an International Non-Government Organisation• Health and Family Welfare Department of Government of Gujarat and Training of Trainers (ToT)

group• SEWA Bank• Faculties and Students of National Institute of Design (NID), Ahmedabad• Students of Centre for Development Communication (CDC), Gujarat University• Government at state level and national level• YUVA - a development organisation, Maharashtra• Management and trustees of Disability, Development and Rehabilitation related organisations• Blind People Association• Professionals - Architects, Planners, Builders, Designers, Advocates, etc• Journalists from Electronic and Print Media• United way of Baroda - an umbrella network

LIST OF ORGANISATIONS / INDIVIDUALS

Handicap International is an international organisation specialised in the field of disability. Non-governmental, non-religious, non-political and non-profit making, it works alongside people with disabilities, whatever the context, offering them assistance and supporting them in their efforts to become self-reliant. Since its creation, the organisation has set up programmes in approximately 60 countries and intervened in many emergency situations. It has a network of eight national associations (Belgium, Canada, France, Germany, Luxembourg, Switzerland, United Kingdom and United States of America) which provide human and financial resources, manage projects and raise awareness of Handicap International's actions and campaigns.

Handicap International works in partnership with relevant stakeholders towards an inclusive, barrier free and rights based society. Over the last five years, Handicap International has initiated, supported and facilitated projects in different parts of India with this vision. In the course of this journey, Handicap International has worked with a range of people, communities and organisations, in the development and disability fields.

During the rehabilitation response to the Gujarat earthquake, Handicap International addressed the needs of vulnerable groups, particularly women and people with disabilities who had to struggle to be included in the rehabilitation process. With various partners, Handicap International built the capacity of civil society to include people with disabilities into mainstream development programmes, with the vision that a sensitized civil society would create an enabling environment for enhancing the participation of people with disabilities in the development process. The initiative began with developing the concept of inclusion and its understanding within the Handicap International team. It was then discussed through consultations with many partners and players. The concept was modified and adapted with each consultative review. This process has been an immense learning experience for Handicap International.

Projects which mainstream disability into development have now gained momentum and are on course. As a result, through this publication, Handicap International intends to capitalise on the capacity-building experience for broader sharing and development for the benefit of others. We believe this publication will assist many other organisations, personnel and professionals to learn and build on the experience we have had in building capacity of civil society and Government actors to mainstream disability into development activities. We hope that this publication will inform the reader of the application of this approach – that is the inclusion of disability in development. The objective is to share the experience and learning of our journey, so that the reader can understand the relevance of its application in their organisational programs, projects and activities. The target readership in mind is wide – grass root organisations, tertiary level organisations, Government Organisations (GOs) and Non-Government Organisations (NGOs), International Non-Government Organisations (INGOs), in fact anybody involved in the field of disability and/or development.

There are potentially many national and international uses of this publication – such as aid policy development, program development, planning future projects, adapting existing ones, or as an awareness training tool for staff and partners.

INTRODUCTION

The publication “Disability and Development – a practical approach to inclusion in India” has four main sections : the context, the concept, the approach and the experience.

The context presents an analysis of disability and development interlinkages, and aims to explain disability from a wider perspective. The concept discusses the role of civil society and stakeholders, and the key elements of an inclusive society. The approach presents the implementation of this concept and various initiatives with a range of organisations. The experience shares the outcomes of inclusion of disability into the work and agenda of different organisations and stakeholders.

The reader may read each section independently, as annexes will outline the tools and resources, for example information about human and knowledge resources available for further reference.

Disability is not just an individual issue but a social issue, and it is an issue of rights. People with disabilities face barriers in society's attitudes and in the built environment. They are often excluded from all aspects of mainstream development activity. This exclusion results in a denial of rights and a situation of additional handicap. Impairment and disability are as old as history; they always have been and will always be with us. If society includes people with disabilities, they can have the opportunity to live meaningful and productive lives.

CHAPTER - ONE

THE CONTEXT

DISABILITY AND HANDICAP

A person with a disability is a human being with physical, sensory and/or intellectual impairments due to diseases, genetic factors, trauma, malnutrition or accident. But disability is not merely an isolated health issue for a particular individual. It also has distinct social implications. Being disabled is a complex human experience. People living with disabilities encounter the medical, social, educational, economic and psychological aspects of their disability through interactions with family, community, the market, the Government and other institutions and services.

DIFFERENT TYPES OF DISABILITIES : Disabilities are categorised in terms of definitions of disability and various clinical conditions. The classification below is based on the Persons with Disabilities (Equal Opportunities, Protection of Rights and Full Participation) Act, 1995 (PWD Act, 1995) and the National Trust for Welfare of Persons with Autism, Cerebral Palsy, Mental Retardation and Multiple Disabilities Act, 1999 (National Trust Act, 1999) :

• Loco-motor disabilities/physical disabilities;

• Cerebral palsy;

• Intellectual disability;

• Mental illness;

• Hearing and/or speech impairment;

• Visual Impairment (low vision and blindness);

• Multiple disabilities – deaf blindness etc

• Psychiatric disability/mental illness

• Others – Autism, specific learning disabilities, leprosy cured etc.

1

IMPAIRMENTLoss of physiological, psychological and anatomical part and/or its function

DISABILITY (ACTIVITY LIMITATION)Due to impairment a person is unable to do his/her functional activities like sitting, standing, walking, feeding, toileting, hearing, seeing etc.

HANDICAP (PARTICIPATION RESTRICTION)Disability is permanent and because of deeper issues emanating from society such as negative social attitudes and barriers within the built environment, the person is unable to undertake activities of daily living and to perform his/her life roles in society.

For example, a person who was a clerk has lost his vision because of diabetes. This anatomical loss of a body organ is an IMPAIRMENT. He is unable to see because of the above. This leads to a DISABILITY (ACTIVITY LIMITATION) as he is unable to do his daily functional activity, such as moving from one place to another, reading, writing, etc. He is not able to pursue his previous occupations and earn for the family and socialize. This response to external factors is HANDICAP (PARTICIPATION RESTRICTION).

DISABILITY PROCESS :The World Health Organisation (WHO)'s international classification of impairment, disability and handicap

1was developed in 1980 and revised in 2001, to become the International Classification of Function (ICF) The ICF explains the disability process from the point of view of participation in activities and society.

Resource List for Website Information 1See

12

Disease Accident

Impairment DisabilityActivity

Limitation

HandicapParticipationRestriction

(ICF) WHO

Earthquake Injury – CAUSE Weakness / paralysis in legs - IMPAIRMENT

Inability to stand / walk – THE DISABILITY- Activity Limitation

Restricted life roles/participation-HANDICAP - Participation Restriction.

stwhich is on the 1 floor, she is unable to participate in the school games as all of them require the ability to strun, and she cannot use the toilet as the 'girl's toilet' is situated on the 1 floor. This is HANDICAP

(Participation restriction).

Being disabled is not the same as experiencing a situation of handicap. Disability, in combination with restricting factors such as negative attitudes and barriers formed by the built environment, results in a situation of handicap. While personal factors such as functional ability play a crucial role in overcoming them, a situation of handicap is created usually because of one or more external environmental factors such as social attitudes, stigma, extreme poverty, lack of information and limited access to quality services. Handicapping situations perpetuate the exclusion of people with disabilities from mainstream society by preventing them from achieving their full potential. When people are forced to live in handicapping situations, they experience a loss of freedom and a violation of their human right to a life of dignity and equal opportunity.

It is the duty of the society and the state to ensure that environmental and situational barriers are removed as a prerequisite to the equal participation of people with disabilities in society. These barriers revolve round the following factors:

Another example is a child with Polio, who has no strength in her legs due to muscle paralysis. This paralysis is an IMPAIRMENT. Because of this impairment, the child is unable to stand, walk, or go to the toilet. This is a DISABILITY (Activity limitation). The child's extent of handicap will not only depend on her disability but largely on the environment; She is unable to climb up stairs and attend her class

13

SOCIAL• Attitudes and stereotypes, family roles, socio-economic conditions, communication barriers, etc.

INSTITUTIONAL• Quality and accessibility of education, rehabilitation and health services, transport or

communication systems and services, extent of inclusion in disaster preparedness plans, etc.

ECONOMIC• Cost of therapeutic services, assistive and adaptive devices, employment opportunity, skills, etc.

PHYSICAL • Barriers in the built environment, spaces and transportation as a result of designing and planning which denies equal opportunities to people with disabilities.

POLITICAL• The law of the land and its implementation, state policy including adherence to the international

instruments, entitlements, political representation, etc.

It is necessary to acknowledge disability as a human rights issue. A Rights Based Approach (RBA) would ensure that people are aware of people with disabilities, their vulnerability and their right to access health, education, employment and social interaction. The RBA recognises disability as a development issue and promotes people with disabilities to become actors and advocates for change.

DISABILITY AND POVERTY

Despite the country's fast-growing economy, poverty in India is stark and debilitating. Many of the factors associated with poverty increase people's risk of disease and disability on the one hand, and reduce their capacity to overcome disability on the other. These factors include ill health and the threat of disease, poor levels of nutrition, hygiene and sanitation, limited access to maternity care, basic vaccination and the lack of access to information.

INDIA HAS MORE DISABLED PEOPLE THAN THE TOTALPOPULATION OF SOME FAIRLY LARGE COUNTRIES

Million People

100%=1,000 Millionpeople (India's population)

Non-disabledpeople

Number ofdisable inIndia

UK'Spopulation

Canada'spopulation

Australia'spopulation

6%*93-94

>60

59

30

19

* Conservative figure ; unofficial estimate are around 10-11% Source : NCPEDP

Disabledpeople

4

CAUSES OF DISABILITY : Poverty, lack of education and information has been identified as the most deep–rooted causes of development of disability. Specific causes include nutritional deficiency, disease, accidents, dangerous working conditions, a lack of basic health and rehabilitation services in poor communities, genetic factors and other unknown causes. Most of these causes are related to poverty and lack of education, and can be prevented.

Over 300 million Indians live in such conditions and often in poor, rural communities where access to basic measures is constrained by lack of information, limited available services, and the costs associated with travel and care. The majority of impairments experienced by the poor, arising from poor nutrition or infections for example, are preventable.

Poverty is also the consequence of disability. In India, people with disabilities face social stigma and are even refused jobs because of their disability. They must pay for medical care, including travel costs to far away places where services can be found, and also cope with economic losses in terms of wages lost for time spent on caring for their disability. These losses are also born by members of their family/other care givers. Sometimes people with disabilities are abandoned or left to care for themselves.

Research in rural India reveals that families with disabled members are poorer than those without disabled members. One study states that the former have lower total assets (amounting to less than Rs. 5000),

2smaller land holdings and larger debts .

3Thus, poverty and disability reinforce each other, trapping people with disabilities in a vicious cycle that puts them at an ever-worsening double disadvantage.

Poverty DisabilityProfound

SocialExclusion

Social and culturalexclusion and stigma

Denial of opportunitiesfor economic, social and

human development

Deficits in economicsocial and cultural rights

Reduced participation indecision-making and

denail of civil and political rights

Susan Erb & Barabara Harriss-White (2002) “Outcast from Social Welfare”, Books for Change, Bangalore.DFID (February 2000), “Disability, Poverty and Development”, UK:

http://www.dfid.gov.uk/pubs/files/disability.pdf

5

DISABILITY AS A CROSS CUTTING ISSUE

Although disability is closely linked to poverty, it is not only restricted to poor people. Other major causes of impairment like war, trauma/accidents and old age, irrespective of gender or class, affect all strata of society. Disability is not just a developing country phenomenon, it is also found in the developed world. The proportions of various impairments may vary in different populations but it can affect anybody of any background at any time. It is found in children, adults and elders, both male and female, and in all sections of society. Thus, disability is a cross cutting issue across all areas of human development including health, education, employment, social integration and political participation.

Most disability issues have multi-sector implications and are best addressed effectively not only within the framework of a single sector, but cross-sectorally. The many cross-cutting disability issues include high rates of poverty and vulnerability to poverty; difficult access to human, productive and other resources; high prevalence in countries affected by conflict and disaster, high correlation with violence, abuse and neglect.

The relationship between poverty and disability is concentric. The limited data that is available suggests that most of the people with disabilities live below the poverty line in developing countries. For example, it

4is estimated that people with disabilities make up to 15 to 20 percent of the poor in developing countries . However, there is still a lack of detailed research on the links between poverty and disability, even though it has been suggested that 50% of impairments are preventable and directly linked to poverty.

The main linkages between disability and vulnerability are: 1. Unhealthy and risky living conditions, such as inadequate shelter, water supply and sanitation, unsafe traffic and working conditions; 2. Absence and inaccessibility (due to environmental and/or monetary barriers) of timely and adequate health care and rehabilitation; 3. Restricted access to education and employment; 4. Exclusion from social life: people with disabilities often do not have access to public places because of physical barriers and often cannot participate in political decision-making;

Thus true development cannot take place unless and until programs and policies are designed keeping disability along with other vulnerable groups in mind. Thus disability is a cross cutting issue, which requires a conscious, coordinated, collaborative and multi-dimensional approach.

4 Anne Elwan (December 1999), “Poverty and Disability – a background paper for the World Development Report”, World Bank.

6

DISABILITY AND GENDER

Women as a group are more vulnerable regardless of their caste, class or religion. Several problems are common to all girls and women whether or not they have a disability. For example, access to healthcare, education and employment is generally lower than for men. Disability adds to this vulnerability and aggravates the situation. Women with disabilities are not considered competent to fulfil the role of a homemaker, wife, daughter and mother. They are often looked down upon by their communities and also their own families. Lack of access to health, education and employment opportunities increases their vulnerability to disease and disability. They are also vulnerable to sexually abusive relationships. A study

5in Orissa revealed that almost half the 595 women with disabilities surveyed faced violence from family 6members and many were raped and molested. A study in Gujarat found significant differences in marital

status and acceptance of women with disability within families. Many women were abandoned by their husbands if they developed a disability after marriage; many disabled women were married to a disabled person or to someone who would not have been considered acceptable as a husband to non-disabled members of the family. Many women who contribute to household activities often do not disclose their disability (if it is mild) and are not seen as 'disabled', whereas men with mild disabilities are more visible as 'disabled' people as they are often unable to find suitable jobs outside their homes.The most vulnerable and neglected among women are women with disabilities. They suffer double discrimination, both on the grounds of gender and impairment. In case of multiple levels of vulnerabilities such as gender, class, caste, ability and economic status, the situation is worse. They not only face the normal difficulties disability imposes, but are also socially excluded.

5 th Oxfam India / Swabhiman (15 March 2005, The Telegraph, Calcutta), “Nobody's Children”6 UNNATI / Handicap International (2004), “Understanding Disability – Attitude and Behaviour Change for Social Inclusion”.

7

DISABILITY AND VULNERABILITY

People with disabilities who are amongst the poorest of people, especially women, suffer profound social exclusion. This means that they experience gross inequities in terms of their access to health, rehabilitation, information services, education, economic opportunities and other fruits of development activities.

In India, some social groups already experience such discrimination more than others, based on their gender or social status (caste). Their disability only compounds their vulnerability. It reduces their access to rehabilitation, forces them to live with stigma and results in a further lack of access to resources.

7National statistics reveal that 55% of people with disabilities in India are illiterate (about 20% more than the national average) and only 9% of them go on to complete secondary or higher education. A mere 1.5% - 3.5% of people with disabilities complete any vocational training and only a quarter of all disabled persons find employment. 47% remain unmarried. The situation of persons with intellectual disability is significantly worse.

Recognizing HIV/AIDS and its link with disability is a must for three reasons; 1. First, because HIV/AIDS is one of the most widespread disabling epidemics in the world today;2. Second, because people with motor, sensory and intellectual disabilities are among the most

8vulnerable to the impacts of AIDS ; and 3. Third, because preventing and treating HIV/AIDS requires a response to a global call for action that

invites all sectors and all actors to use their strengths and diverse capacities to collectively reduce the impact of the disease on communities around the world.

Environmental factors such as stigma and discrimination in society and the workplace or poor access to appropriate healthcare either because of distance, cost, or lack of medication are also disabling for people living with HIV.

7National Sample Survey Organisation (NSSO) data (2002-03), India.8 Vulnerability to the impacts of AIDS refers to the likelihood of suffering adverse consequences from the effects of excess morbidity and mortality caused by AIDS. Can be applied to individuals, or groups of people such as households, organisations, or societies. Vulnerability is determined by poverty, fragmented social and family structures, and gender inequality. Sue Holden (2003), “AIDS on the Agenda Adapting Development and Humanitarian Programmes to Meet the Challenge of HIV/AIDS”, Published by Oxfam GB, in association with ActionAid and Save The Children, UK.

8

• Only 0.1 million peoplehave been employedin last 40 years

• Only about 3500disabled are employedeach year

• Unemployment isvery high despite a 3%reservation in allgovernment jobs

DISABLED PEOPLE IN INDIA ARE MOSTLY UNEMPLOYED

Avg. ofdisabledunemployed in USA

Avg. ofdisabledunemployed in developingcountries

Disabledunemployed in India

72

85

99

Source : World Development Indicators 2001

People with disabilities are at equal or greater risk of HIV infection, compared to their non-disabled peers. The stigma experienced by these means that they are less likely to marry and more likely to have several sexual partners in a series of unstable relationships. Disabled women, men and children are three times

9more likely to be victims of sexual violence and rape . Other factors such as physical dependence, life in institutions and lack of access to legal rights, also make them particularly vulnerable to infection and abuse.

People with disabilities have poor access to HIV/AIDS information and services. Only 1-2% of children with disabilities receive an education, therefore they automatically miss out on school based HIV/AIDS education programmes. Low literacy rates among disabled adults and difficulty with access to mass media messages for those with hearing or visual impairments also present real challenges to information outreach. Access to HIV testing, care, medication and support is limited due to social and economic obstacles, problems of physical access, prejudicial attitudes towards people with disabilities and misconceptions that they are not sexually active.

People with disabilities are left out of HIV/AIDS policies and programming. Despite growing international attention to the rights of people with disabilities, many governments and policy makers rarely consider disability issues when formulating their HIV/AIDS strategic plans.

People with disabilities require equality of access so that they can live full lives. Removing the barriers they face and maximising their abilities involves creating the minimum conditions for their inclusion in society in all aspects of life education, work, health, sports and recreation and living conditions.

9 Dick Sobsey (1994), “Violence and abuse in the lives of people with disabilities: The end of silent acceptance”, Paul H. Brookes Publishing Company, Baltimore: http://normemma.com/artfvioabu.htm; http://satchawaii.com/statistics.html; http://www.ualberta.ca/~jpdasddc/about/sobsey-cv.html

9

DISABILITY AND HEALTH

10Disability may result from an impairment, which in turn could be caused by disease or trauma . The most common causes of locomotor disabilities are injuries from accidents on the road, at home or in the workplace, through war and violence, birth trauma and infectious and non-infectious diseases such as diabetes. Malnutrition is one of the major causes of disability amongst children. According to estimates from the WHO, pregnancy and child birth and their consequences are still the leading causes of death,

11disease and disabilities among women of reproductive age in developing countries. These are all directly related to poor working, living and financial conditions and therefore are preventable. Similarly, a majority of impairments arising from poor nutrition or infections are also preventable. There are a range of national programmes against diseases and impairment prevention but the access and usage of these are constrained by lack of information, services and the cost associated with travel and care. Disease and impairment prevention is the main focus of Primary Health Care Programmes. However, according to a

12study in Gujarat , 63% of the villages covered did not have a Primary Health Centre (PHC) located nearby. This means that for access to health care, travel to another village where a PHC is located is required. Travel requires access to resources such as money and time, which many poor people do not have; hence for the poorest people, access to healthcare is limited and likelihood of an impairment becoming a disability increases. Merely 10% of population access primary health care in tribal areas.

About 50% of these causes are preventable and linked to poverty

Ø 50% of all disabilities are preventable.Ø Health care services have a paramount role in preventing impairments.Ø Inadequate training of health professionals is one of the major impediments in carrying out prevention of disability and care of disabled persons. Ø Inadequate primary healthcare services increase health risks for people with disabilities. Ø Rehabilitation services are still not part of health services and are often not accessible, therefore disability is exacerbated.Ø Inaccessible transportation facilities or roads make it almost impossible to reach the nearest town to seek medical help.Ø Costs of medical care and transportation is unaffordable for lot of people.

SOME GROUND REALITIES

10 Anne Elwan (December 1999), “Poverty and Disability a background paper for the World Development Report”, World Bank.11http://www.who.int/whr/2005/media_centre/facts_en.pdf12UNNATI / Handicap International (2004), “Understanding Disability Attitude and Behaviour Change for Social Inclusion”.

CAUSES OF IMPAIRMENT

20 %

13 % 20 %

16 %

11 %20 %

Malnutrition

Accident/ Trauma/ War

Infectious Disease

Non-infectious Disease

Congenital Disease

Others (including aging)

10

Another key factor is prevention of disability. Not every impairment leads to a disability - early intervention and awareness of precautions can significantly reduce the disability. For example, a preventable eye

13infection or ear infection, if not treated, could cause permanent damage. The Gujarat study found that village health workers were unaware that mental illness and intellectual disability are also types of disabilities and that, in general, the staff of most PHCs had limited information on the various causes of disability. There seems a clear gap in the capacity of health service system to identify people at risk of developing disabilities, and in the capacity of health professionals to know how to refer people to specialist services in order to prevent disability.

Even after someone has a disability, the impact of disability can be minimised by appropriate rehabilitation - through training, therapeutic services or assistive and adaptive devices. In India, it is believed that between 5-10% of people with disabilities have access to or are reached by any kind of

14rehabilitation or social services . Although disability is more prevalent in rural areas, only 20% of rehabilitation services are located in rural areas. The first major intervention for disability management is often at the district centres or city hospitals, which are not easily accessible to many people living in villages. Community Based Rehabilitation (CBR) services have not reached everywhere and lack of information and resources are restricting its reach.

A majority of people with chronic disability require medical follow-up or aftercare for medication, therapeutic review and adjustment of assistive and adaptive devices. For example, a wheelchair user is prone to pressure sores, a person with spinal injuries is prone to secondary infections, a person with mental illness requires careful monitoring of medication side-effects, a child with polio will need readjusting of callipers and walking aids at regular intervals. People with disabilities have the same, if not more need of medical services, and yet the medical system often is inaccessible. Often people with disabilities are abandoned or left to care for themselves.

There are more men with disabilities than women in India. One possible explanation could be the overall lower female sex ratio; however, an alternative explanation could be that girls and women with disabilities receive less care and support and therefore die earlier than men with disabilities.

13 UNNATI / Handicap International (2004), “Understanding Disability Attitude and Behaviour Change for Social Inclusion”.14 http://www.disabilityanddevelopmentpartners.org/accesstorehabilitation.htm

11

DISABILITY AND EDUCATION

15In India only about 2% of children with disabilities receive an education . Similarly, people with disabilities are more likely to be denied access to employment. This results in driving them deeper into poverty.

16Communities that were studied in the Gujarat project reported a high drop out rate from school amongst children with disabilities. Girls with disabilities dropped out more frequently than boys due to several reasons, including vulnerability to abuse and exploitation, lack of proper accessible toilets and the prevailing social belief that it is not worth investing in education for girls. The number of children with disabilities is even lower when it comes to secondary school and almost zero at higher schools. This is mainly due to access difficulties; as secondary or high schools are generally further away from villages, and there is lack of adequate transport facilities for youth with disabilities to travel there. For persons with sensory disabilities (visual or hearing impairment), it is even more difficult, as the education system is unable to accommodate their learning needs.

There exists a strong social scepticism of the relevance and benefits of enabling people with disabilities to 17access. People interviewed in the Gujarat study believed that a person with disabilities lacks the

capacity to perform certain tasks and that they are dependent on a non-disabled person in many ways. Although there were positive stories and examples that were shared, there seemed to be a certain negative attitude towards the ability to generalise such positive experiences across other contexts. The success stories were seen more like exceptions and other disabled people were not seen as having the same potential or capability.

MORE THAN 98% OF THE DISABLED CHILDREN GET NO EDUCATIONPercent of children receiving primary education

Developing country average

Avg. of disabled indeveloping countries

India

disabled inIndia

85-90%

65-75%

70-75%

35-45%

60%

2%

Developed country average

Avg. of disabled indeveloped countries

Fraction of total population

Fraction of disabled peopleUnofficial estimatesSource : World development indicator 2001. country paper on disability statistics, China disabled person federation

15 World Development Indications (2001): Country Paper on Disability Statistics: CPF.16 UNNATI / Handicap International (2004), “Understanding Disability Attitude and Behaviour Change for Social Inclusion”.17 UNNATI / Handicap International (2004), “Understanding Disability Attitude and Behaviour Change for Social Inclusion”.

12

Basic services, including water and sanitation services, are as necessary for a person with disabilities as they are for the rest of population. Access to safe water and sanitation is a critical service for everybody; however, people with disabilities experience many difficulties in accessing such services. Most of these problems are simply because of environmental and physical barriers. Many other vulnerable groups of people also experience difficulties using water and sanitation facilities, such as frail and elderly people, pregnant women, parents with small children, and people who are injured or sick including people with HIV/AIDS. According to the Gujarat study, lack of accessible sanitation facilities was a critical factor amongst female students dropping out of school or amongst those with restricted mobility outdoors. In urban areas, inaccessible toilets at work and in the community for example markets, shops or places of entertainment, exclude people with disabilities from participation. The magnitude of difficulties is huge in a rural setting where sanitation facilities are far away from main living areas and are often regulated by social customs and time bounds in many parts of India, women particularly are expected to use the sanitation facilities before daybreak. People with disabilities remain excluded from the mainstream society because many public places are out of their reach.

DISABILITY AND WATER AND SANITATION SERVICES

13

DISABILITY AND ECONOMY

18 Robert L. Metts (2004), “Disability and Development background paper prepared for the Disability and Development Research Agenda Meeting”, World Bank Headquarters, Washington D.C.19 Presentation of the World Bank India Disability Study at the Disability Knowledge and Research Round Table II (2005), Ahmedabad.20 Draft incentives policy to promote employment opportunities for people with disabilities in the corporate sector (2003), NCPEDP, HI and the EU.

14

Disabled employed

Disability not only affects the individual and her/his family but has an impact on the whole community. The cost of excluding people with disabilities from taking an active part in community life is high and is borne by society. The exclusion of people with disabilities leads to loss of productivity and human potential. In the late 1990s, estimates of Gross Domestic Product (GDP) loss world wide due to disability were between

18US$1.4 and US$1.9 trillion . Estimates for India are unknown, but believed to be high. In a village study in 19Tamil Nadu , aggregate costs of disability (both direct and indirect) were found to be 8% of the total

village income.

The economics of disability can be analysed according to the cost of disability and the lack of employment opportunities for people with disabilities. The first cost of disability is the loss of income forgone by a person with a disability, as a result of activity limitation. The second is the direct cost of rehabilitation and support services, including costs of travel and loss of wages. The third type of cost is usually hidden the indirect cost to care givers, which tend to be unequally shared amongst female family members. In India, many young girls are forced to forgo their schooling to take care of disabled family members. This has the hidden and yet long term damaging effect of a significant reduction in the quality of life of a future generation.

The human potential and productive capabilities of people with disabilities in India is under exploited. Few hold public jobs despite a 3% reservation for them. In a recent study, the average rate of employment of persons with disabilities in the private sector has been found to be a mere 0.28% and

200.05% in multinational companies operating in India .

DISABILITY AND GOVERNANCE

Governance refers broadly to the exercise of power through a country's economic, social and political institutions in which institutions represent the organisational rules and routines, formal laws, and informal norms that together shape the incentives of public policymakers, overseers, and providers of public services. This is often referred to as "the rules of the game." Three key dimensions are (a) the process by which governments are selected, held accountable, monitored, and replaced; (b) the capacity of governments to manage resources efficiently and to formulate, implement and enforce sound policies and regulations; and (c) respect for institutions that govern economic and social interactions.

This includes participation of people with disabilities at all levels including selection of government (includes voting), monitoring, formulations of policies and programs and its effective execution and implementation. However, physical and attitudinal barriers restrict them to play these roles effectively and do not allow them to make valuable contributions in the processes of governance.

Over the years, as disability awareness and advocacy has developed, various frameworks and regulations national, regional and international have been formulated to guide policies and practices for governance that includes and addresses the needs and rights of people with disabilities. The Biwako Millennium Framework (the Asia-Pacific framework for disability action), United Nations Universal Declaration of Human Rights (UNUDHR) 1948, United Nations Convention on the Rights of Disabled Persons (UNCRPD) and Indian laws such as the PWD Act, 1995 are a few such regulations.

Although these statutes recognise the issues and are national, regional and international cornerstones for the rights of disabled people, the awareness and implementation of these regulations remain low.

21Handicap International's strategy paper notes that the central and state government policies towards people with disabilities in India remain largely 'welfare' orientated. Public resources under the Ministry of Social Justice and Empowerment (MSJ&E) are allocated to a variety of programs for treatment, rehabilitation and development through improved outreach and services for people with disabilities. Efforts to include them are not, as a rule, mainstreamed under relevant ministries. However, there is the

22example of India's new 'Education for All' policy that makes special efforts to include children with disabilities in mainstream schools; and India's ratification of the UNCRPD means the nation is committed to including children with disabilities into education.

The mixed approach containing ingredients for both 'rights' and 'welfare', sometimes creates a gap between 'what is' and 'what ought to be'. The major concern is that while governance is coming to terms with what may be needed, civil society's attitude and approach is far from 'rights based' and essentially 'welfare' focused. This delays the process of awareness and implementation of the regulations.

21 HI India Country Strategy (2004-2008).22 Sarva Shiksha Abhiyan (SSA), Govt of India.

15

A SUMMARY

• The impact of disability is closely linked to the social, attitudinal and built environment.

• People with disabilities have multiple vulnerabilities and are often excluded from various development activities.

• The disability increases with lack of development and generates a situation of exacerbated poverty.

• All individuals need services, but society's response to the needs of people with disabilities is not adequate. This is evident in the exclusion and lack of access of disabled people to the most basic services.

• Disability is a development issue and therefore can best be addressed through inclusion in alldevelopment activities as a cross cutting issue.

16

Groups can then be divided in terms of disability type (locomotor, visual, communication) where they bring together their observations and analysis. This is then presented to the other groups.

ACTIVITY SUGGESTIONS :The objective of this session can be achieved through use of blindfolds (simulate blindness), use of mobility aids with legs strapped together with bandage or straps (simulate amputation/ locomotor disability), taping the fingers/thick gloves or strapping an arm with a crepe bandage (simulate leprosy, amputation or hemiplegia) and application of headphones and following instructions like, no use of speech (simulate hearing/communication disability). Other disabilities like mental illness, multiple disabilities or learning disabilities should be included in discussions and not ignored.

The participants are given a specific task an everyday routine task for example using the toilet, changing shirt/shoes, using the public phone, paying somebody (handling money), buying something from the shop outside, getting a drink, having lunch, reading/handling a newspaper, seeking information from others or expressing their own messages without speech.

Participants then discuss their observation and experiences in their group and present to a larger group later. The groups could be organised according to disability types (locomotor, visual, speech and hearing) and discussion themes may include:

• How did it feel to be a disabled person?• What difficulties did you experience while performing the task?• What difficulties did you feel as an observer or assistant? (For observers' group).• What difficulties might a person with disabilities face in everyday life ?• What might a person with a disability expect from the society?

Debrief of group presentations can include sharing the actual situation of people with disabilities from relevant reliable sources like census data, National Sample Survey Organisation (NSSO), etc for example: number of people with disabilities, number of children with disabilities who are getting education, number of people with disabilities who have employment, etc.

34

The previous chapter presented an analysis of the context, highlighting that disability increases when not included into development initiatives; a situation of handicap is generated in the absence of opportunities for participation in social activities and development. It is evident that people with disabilities and their families are excluded from mainstream development. In this chapter, we will identify the players, the means and the approach to eradicate exclusion.

THE CONCEPT

Traditionally, disability has been treated as a health and welfare issue. As a 'health' issue, it requires treatment or rehabilitation by health professionals or rehabilitation specialists. Rehabilitation is focused towards learning and improvement in the abilities of people with disabilities for their full participation in the society either through training, therapeutic services and/or assistive and adaptive devices. This focus necessitated specialised centres and specialist professionals. For people with severe disabilities, a 'welfare' approach was recommended, where support services or institutionalised care were considered the best way to 'look after' them. Both these approaches were particularly inappropriate stand-alone solutions for large developing countries, where resources and access are key considerations.

Later, as the need for more accessible services became apparent, the scope of rehabilitation widened to include families of people with disabilities and the rehabilitation of the persons in their own community. CBR was therefore, developed and implemented with this philosophy. The focus of intervention in CBR is the person with disability and their family, who were rehabilitated using local resources in their own community. This promoted easy access to rehabilitation services at their doorsteps. However, the CBR

23experience highlighted that its scope needs to evolve and broaden to interlink with two other major elements prevention of disability and development of opportunities for inclusion of disabled people.

PROCESS OF REHABILITATION : The main components of rehabilitation are as follows:

1 Prevention : prevention before occurrence of diseases or injury for example through proper diet, sanitation, vaccination, education and work opportunities. This area is covered mostly by the primary health care system.

2. Intervention: the treatment done after the onset of diseases or injury, for example application of plaster after fracture, surgery and therapy.

3. Rehabilitation: helping the person to become independent capitalising on his/her remaining abilities and creating conducive environments for opportunities as equals (for example in schools and at work etc). The ultimate aim is optimum utilisation of the remaining abilities of the person.

THE TRADITION … DISABILITY REHABILITATION

23 Maya Thomas & MJ Thomas (Eds) (January 2001), “Asia Pacific Disability Rehabilitation Journal”

CHAPTER - TWOCHAPTER - TWO

17

The rehabilitation hut is a tool to explain comprehensive rehabilitation. It demystifies the medical notion of rehabilitation and emphasises its inclusive nature. The step-wise building of the hut also categorises different components of rehabilitation that is from the foundation to the roof. Medical and therapeutic services include corrective surgery, physiotherapy, occupational therapy, speech therapy and counselling, which form a foundation. Assistive and adaptive devices, serve as a wall which supports individuals to be functional in all situations. Social and political rehabilitation represents a door which allows persons to interact with one another, and their inclusion and acceptance in society. The window describes their educational rehabilitation which introduces people to knowledge as the light of the world. The roof highlights economic rehabilitation, without which financial and social security is in question. All the components of the house are equally important and all put together, the parts make a complete house. This model also acknowledges that rehabilitation need not always start from scratch and follow steps one after another; it is more needs based and can occur simultaneously.

As seen in the analysis within chapter one, the challenges faced by people with disabilities are enforced also by attitudinal and environmental barriers in society. Major challenges faced by them are lack of opportunities for education, employment, social integration and involvement in self-development. Therefore, an approach targeting a person with disability alone ignores the attitudes of the wider community, which often exclude people with disabilities from mainstream development. People with disabilities have the right to be rehabilitated but they also have the right to participate and contribute to society, and to achieve that, society needs to participate in rehabilitation.

REHABILITATION HUT

2. Support Services, assistive & adaptive devices

4. Educational Rehabilitation

1. Medical & Therapeutic Rehabilitation

3. Social & Political Rehabilitation

5. Economic Rehabilitation

18

Models of Disability: A major contribution made by people with disabilities is in form of description and development of “the models of disability”. These are the frameworks which help to explain the ways in which society responds to disability and appropriateness of its responses.

The Charity Model tends to view disabled people as victims of impairment and as the beneficiaries of hand-outs and services. Disabled people are viewed as tragic or suffering people to be pitied and cared for. It has been assumed that it is society's responsibility to arrange all services for them.

The Medical Model perceives disability as problem located in the disabled individual and assumes that working on the medical problem can solve it all. The disabled person becomes defined solely in terms of his or her diagnosis as a patient with medical needs and no longer as a person with a whole range of needs. All the interventions recommended in this model are therapeutic in nature, and it ensures that people with disabilities like any other sick persons should be taken care of well.

THE COMPREHENSIVE APPROACH: DISABILITY IN A SOCIAL AND RIGHTS-BASED CONTEXT

Independent/selfdecedent

communities

Active Society

Poverty reduction

& economicopportunities

for all

Employmentopportunities

Barrier free environmentand services

Rights &entitlement for all

SOLUTIONINCLUSIVE & ENABLINGSOCIETY

Accept Diversities& differences

Adequate and qualityeducation

AccessibleTransport

Inclusion &main streaming

Non-discriminatingenvironment

Adequate and quality services

Rights based model-Solution

PositiveDependency

Poverty andEconomic

Dependency

No Jobs

InadequateEducation

Inaccessible Buildings(school, offices, hospitals)

No Rights

PROBLEM=DISABLED

SOCIETY

DIFFERENT ABILITIES

Inadequate Service(Medical, Rehabilitation

and Social etc.)

InaccessibleTransport

IsolationSegregation

PrejudiceDiscrimination

The Social Model of Disability-Problem

Can't Walk, Talk or See

Needs Looking

After

To Be Pitted

Brave Courageous Inspirational

Sad, Tragic, Passive

BitterTwistedAggressive

PROBLEM=DISABLEDINDIVIDUAL

The Charitable Model of Disability

SpecialInitiations

ShelteredEmplyment

SpecialTransport

PROBLEM=DISABLEDINDIVIDUAL

SpecialSchool

SpecialWorkers Hospitals

TherapistsSpecialists

Care

PatientCase

Can't WalkTalk, See Decide

Welfare SocialServices

Cure

The Medical Model of Disability

19

The Social Model considers that the problem lies with the society thus people with disabilities are excluded. It proposes to upgrade and improve society so that their inclusion is not an alien issue. This model identifies three major barriers that confront disabled people: physical (exclusion from the built environment), institutional (systematic exclusion or neglect in social, legal, educational, religious, and political institutions) and attitudinal (negative valuations of disabled people).

The Rights Based Model, however, focuses on reaching a solution which benefits a large number of the population, including people with disabilities. The RBA addresses the issues from the perspective that changes need to be brought because people with disabilities also have human rights, the achievement of which are the joint responsibility of all the stakeholders. The solutions to problems of disability must therefore come from change within the families, communities and societies in which person with disabilities are living.

The comprehensive approach recognises the barriers placed by society, which restrict access of disabled persons and works to eliminate the same. As the understanding of the social nature of disability has developed, the social model of disability has broadened the focus to promote integration of people with disabilities within society by removing these barriers. Rehabilitation conducted within a social framework is about the removal of barriers at the individual level and also about the legislative, physical and attitudinal barriers from society. This includes protection of rights, provision of equal opportunities in education, health and employment and other aspects of mainstream development and opportunities.

The analysis above would suggest that the social approach has two main facets: rehabilitation and inclusion. Rehabilitation optimises the ability of people with disability through training, therapeutic services, skill development and assistive and adaptive devices. This is critical as many difficulties faced by them can be minimised through appropriate rehabilitative input. For example, a child with hearing impairment may benefit from a hearing aid and speech therapy to learn or relearn their ability to communicate; a child with polio may relearn to walk with callipers and training; an adult with visual impairment can mobilise safely after mobility and orientation training. Some people with disability need rehabilitation, medication management and monitoring, or supported education and work, which can only be provided in a specialised environment. However, many of them do not need specialist services and face challenges in the negative attitudes, social exclusion and environmental barriers, which limit their participation in mainstream services, a cost-effective and efficient way to provide services to the whole population. Thus, alongside rehabilitation, the importance of developing the inclusiveness of existing social infrastructure cannot be ignored.

20

THE WAY FORWARD....DISABILITY IN DEVELOPMENT

A deeper reflection to investigate the reasons for existing negative attitudes towards disability demonstrates a complex picture. Our assumptions regarding the causes of disability are based on religion and culture, whether it is believed that a disability results from 'karmas' in the last birth or as a punishment that God has imposed. This fatalistic attitude may induce an acceptance of the situation as it is.

The way society views its role towards people with disabilities is also informed by its assumptions and beliefs; typically, many societies believe that they need charity and welfare. There is a tendency to stereotype people with disabilities as people lacking potential. There also is the tendency to generalise all people with disabilities into one category, ignoring individual variations, abilities or needs.

It is clear that these paradigms are not essentially products of prejudice but more due to ignorance and lack of awareness about the needs, situation and potential of people with disabilities. A greater awareness in many developed countries has led to a significant increase in disabled people being able to access equal opportunities. This has been achieved through, among other things, legislation, adapting the

24environment and including disabled children into mainstream schools .

For developing countries, the way forward is to change attitudes through development of greater awareness in a way that promotes opportunities for inclusion of people with disability into health, education, work and society, enabling equal access to opportunities for all. This can be achieved through a combination of advocacy within the existing governmental system, and inclusion of disability as a transversal target group and issue within development programs. The goal of advocacy towards Government is to adapt legislation, policies and procedures to ensure that the rights of people with disabilities are respected, and that they have equality of access to opportunities. The objective of mainstreaming disability across development programs is to create an enabling environment for people with disabilities in all sectors. To achieve this, mainstream development programs, which may focus on anything from development of the health, education, governance, rural development or infrastructure sectors, must include them as key beneficiaries, and thus adapt project activities so that they are accessible to and inclusive of people with disabilities.

Disability organisations and disabled people have a role to play in raising awareness of development organisations, to teach them why inclusion of people with disabilities is important, and how it can be done. Development stakeholders including bilateral and multilateral donors and organisations, INGOs, National NGOs and grassroots organisations are all key targets for education and awareness-raising. Without inclusion of people with disabilities into development activities, they, often the most marginalised of the poor, will have little to gain from development programs.

The recognition of the reality that disability, like gender, is a cross cutting issue in development related work, and the active inclusion of disability as a transversal issue across development activities, will lead to social acceptance of people with disabilities, and will facilitate opportunities for people with disabilities to partake of the outcomes of mainstream development.

24 Disability and Development the Basics, in Disability and Development.

21

A HUMAN RIGHTS FOCUS...

A key driving force for the work of NGOs with vulnerable groups centres on the issue of 'rights'. Using the RBA to promote awareness has been instrumental in changing the attitudes of many people. Be it children's rights, women's rights, dalit (minority groups) rights or human rights, legislation and advocacy within the social model have paved the way to promote empowerment and inclusion of these groups.

Disability is a cross cutting issue and can be part of every vulnerability. Children's rights should safeguard and include the rights of children with disabilities as well; women's rights should promote the rights of women with disabilities also; although this seems explicit, practice is often inconsistent with this fact. Disability is often viewed as separate or isolated from these groups and hence is ignored or discriminated.

International and national conventions and legislation are changing this. The Government of India (GoI) passed the PWD Act, 1995 and now has specific legislation for the rights and equalisation of opportunities for disabled people. Such legislative backing advocates for creation of opportunities way beyond civic moral responsibility, as it demands equal opportunities and the protection of rights for disabled people. Civil society therefore has to reorient its role beyond charity and morality to responsibility and accountability to the law and protection of rights.

thThe United Nations General Assembly adopted the UNCRPD on the 13 December 2006. The UNCRPD's purpose is to promote, protect and ensure the full and equal enjoyment of all human rights and fundamental freedoms by all persons with disabilities, and to promote respect for their inherent dignity (article 1). It represents a universal undertaking to make our societies inclusive so that persons with disabilities may benefit from the same opportunities and the same possibilities for participation as

theveryone else. The UNCRPD was open for signing on the 30 of March at the UN headquarters in Washington. 81 States and the European Commission (EC) signed the UNCRPD and 43 States signed the Optional Protocol. India was among the first counties to sign. GoI has also ratified

stUNCRPD on 1 October 2007.

Countries that ratify the UNCRPD engage themselves to develop and carry out policies, laws and administrative measures for securing the rights recognized in the Convention and abolish laws, regulations, customs and practices that constitute discrimination (Article 4).

People with disabilities are not seeking charity but demanding their rights. Society must include their needs into planning and development when developing new infrastructure, schools, and hospitals they have to take into considerations the needs of all including those with disabilities. Corporations and organisations must employ disabled people according to the specified quota, employers cannot discriminate on the grounds of disability legislation is in place to protect the rights of people with disabilities. Awareness of the law needs promotion, both to civil society and the people with disabilities. Persons with disabilities always have been and always will be present in our communities. However, the

25way that societies include them can and do change .

25 Handicap International (March 2001) “Understanding Community Approaches to Handicap in Development (CAHD)”, France.

22

26 Darnbrough, Ann, “Disabled Women in Society a Personal Overview”

MAINSTREAMING DISABILITY

26 Disability, indeed is a human rights issue and is not just an individual issue, but a social issue and needs to be understood within a wider social/ environmental context. The focus needs to expand to view disability from a human rights perspective to ensure that people with disabilities can lead fulfilled and dignified lives.

Viewing disability from a human rights perspective shows that the role of stakeholders such as the State, development organisations, community and civil society in addition to rehabilitation institutions and organisations is extremely important. It is also important to identify stakeholders in all spheres of development policy makers, educational institutes, employment providers, service providers in addition to media and local communities.

Mainstreaming disability in development requires the participation of many stakeholders in society. This approach is built on sharing knowledge and experience to help organisations and individuals become familiar with the needs of people with disabilities and explore and enhance their roles in developing disability-inclusive programs.

23

Our vision is to create a sensitised civil society, which will result in an enabling environment for enhancing the participation of people with disabilities in the development process.

To achieve this vision, it was recognised that an approach is needed which challenges and changes the attitudes of people and organisations :

• To acknowledge disability as a human rights and development issue.

• To eliminate and advocate for the removal of barriers that result in the exclusion of people with disabilities.

• To promote inclusion and opportunities for people with disabilities in mainstream development activities.

• To break existing stereotypes and ignorance about disability.

As a result, Handicap International embarked on a process to develop methods to achieve this vision. From the initial planning stages, it was felt that people, communities and society were unaware of the needs and potential of people with disabilities. If they were to become familiar with the needs of people with disabilities it would promote a recognition and acceptance of the need to include them in every aspect of development activities. As a result, they would be perceived not only as a separate vulnerable group requiring specialist services but a group of people with a stake in any kind of development work. The mindset would change and general but inclusive development needs would become the focus for action.

This concept and approach was presented, discussed, formatted and deliberated with many partners and the unanimous conclusion was to develop an intervention with a focus on orienting and sensitising civil society to the needs and situation of people with disabilities. This itself would lead to different stakeholders exploring their roles within development or civil activities and thereby promote opportunities for inclusion within whatever they do. An orientation and sensitisation training module was thus conceived as the critical foundation for inclusion of people with disabilities in mainstream development.

THE APPROACH

CHAPTER - TWOCHAPTER - THREE

CHAPTER - TWOTHE VISION

24

Orientation and sensitisation of civil society stakeholders is identified as the key intervention and target group for this approach.

The orientation workshop focuses on role exploration and enhancement as the key outcome. The participants explore the role of their organisations and explore ways to incorporate people with disabilities into their development work.

Any potential opportunities or specific interventions at individual or organisational level require follow up and monitoring.

Interventions identified should not be resource driven as it is not about starting new activities. The real change sought is attitudinal and a thinking-level strategic change where role enhancement and inclusion of the needs of vulnerable people is encouraged.

The module has a core content that has a universal applicability and yet has the flexibility to adapt and include specific variations for individual or groups of organisations. The module is transferable to be run within an organisation or across organisations or sectors.

The key objectives of this training module are that development organisations, corporate and service organisations understand that in fact people with disabilities have needs just like other vulnerable groups; and disability organisations relate to the rights based perspective and explore their reach into development activities.

CHAPTER - TWOPRINCIPLES OF THE ORIENTATION AND SENSITISATION TRAINING MODULE

25

The orientation programme should be planned with a local player and target a defined area. The local organisation will know the key organisations, networks and groups in their area and therefore will be able to facilitate the bringing together of key organisations and stakeholders. The local organisation should be sensitised to the approach before this.

Training can involve a mixed group of development and disability organisations, at various levels, including governmental and voluntary organisations or representatives, media, and a range of development organisations health, education, rights, governance, basic services, income generation, Self Help Groups (SHGs) and micro finance. Wherever possible, representation of decision makers will ensure a broader organisational change, the representatives can then conduct the programme to sensitise personnel and staff at all levels.

The orientation programme must involve simulation to help participants experience, explore and relate to the needs of people with disabilities. Through this activity, participants experience the difficulties that a person with disabilities may face in everyday activities and in interaction with society. This methodology has been found to be most insightful if planned well. A critical component of simulation is to promote interaction of the participants in their temporary disability situations with others fellow participants or where possible, with society outside the training room. Beyond experiencing the difficulties at the individual level, the participants will relate to the environment and social context in this temporary situation.

Dialogue, interaction and experience sharing with people with disabilities will be another critical consideration in the orientation module. They are themselves a key resource for such orientation and have a key role as participants, facilitators, experience sharing, and resources - in fact involvement at all levels.

Vulnerability analysis and the rights perspective are the foundations of this training module. Familiarity with the situation and needs of people with disabilities, awareness of legislation, services and resources available and realisation of the common development needs of people with disabilities form the cornerstones of this orientation module.

The orientation module aims towards individual and organisational role exploration and role enhancement as the key outcome. Participants will be encouraged to identify possibilities, and opportunities for inclusion within what they or their organisations carry out. The possibilities or opportunities identified may involve 3 levels opportunities within an organisation's activities, opportunities between organisations in terms of resource sharing and cross referral, or area level opportunities through collaboration, awareness or advocacy initiatives. Any intervention or networking and linkages will require follow up and monitoring.

Networking and development of a shared understanding of resources and linkages are the other key outcomes. Some of the intervention possibilities or opportunities may involve a few organisations coming together. At the same time, sharing experiences and knowledge of resources and services in a common

CHAPTER - TWOKEY CONSIDERATIONS WHEN PLANNING THE ORIENTATION MODULE….

26

An orientation and sensitisation module was designed, tested and developed that revolved around these principles and key considerations. Over the years, this module has been utilized and applied with various organisations and networks. It has been utilized with networking organisations, government representatives, academic units, support/donor organisations, development and disability organisations, rehabilitation professionals, doctors, school children, people with disabilities, creative writers, designers, media and corporate groups. It has a participative, interactive methodology and information overload is deliberately kept very limited.

The module intends to focus on developing the knowledge, attitudes and self awareness of participants around issues of disability and the RBA for an inclusive society. The broader aim is to facilitate transformation processes in individuals and organisations towards this goal.

The module has required some modification but the core components and the principles have been endorsed after extensive use with different groups. It has a core content that is applicable universally and allows flexibility to incorporate specific elements e.g. rights awareness, disability understanding or accessibility, to accommodate a group's specified needs. The key objective is to promote inclusion and to change attitudes not to introduce a new need for new programs but a role enhancement. This principle has been endorsed and consolidated. Orientation workshops have brought people together, created and strengthened networking and awareness of the potential to complement each other. The main outcome of workshops is the initiation of inclusion into different development opportunities on the basis of common rights and needs not due to ability or the lack of it.

DESIGNING THE TRAINING MODULE

27

The overall objectives of the workshop are as follows :

• To orient participants to the concept of disability and development.

• To develop understanding of the needs, issues, rights and abilities of persons with disabilities andtheir families in general and women with disability in particular.

• To undertake a participatory analysis of vulnerabilities, stakeholders and their roles and potentialstrategic intervention.

• To orient participants to International, Regional and National Conventions, laws and schemesaddressing the rights and needs of people with disabilities.

• To develop understanding of barriers to inclusion, and accessibility features in the builtenvironment, non built environments and transportation.

• To facilitate identification of the future direction of the individuals and group for intervention in thedisability context.

The programme design is guided by the overall objectives. The session plan outlines the theme of the session, specific objectives for the session, methodology, activities and expected outcomes.

The interventions outlined below offer suggestions of activities that have been found to be useful and reliable in achieving the objectives.

THE MODULE

28

THEME : Knowing each other Introduction of the participants and the facilitators.

SPECIFIC OBJECTIVES : • To familiarise the participants with one another. • To share the objectives and design of the workshop • To set the stage for participatory discussion and learning on disability and development.

SESSION-1: KNOWING EACH OTHER

METHODOLOGY : More than an ice breaker this should open up communication amongst participants, serve as the foundation for networking and generate interest in different organisations and their activities. It has a group building objective. The activity chosen should involve sufficient movement, eye contact and personal interaction amongst participants.

29

ACTIVITY SUGGESTIONS :A cyclic chain method: Participants stand in two rows facing each other; they introduce themselves to the person opposite and the whole row moves to the right (like a cycle chain). This ensures everyone has met every participant. (Space is an important consideration for this activity).

A fishing group activity : A fish cut-out is pinned to each participant's back. The participants have to write positive observations and their perceptions of the good things in that individual on his/her fish cut-out. Participants then read the comments and share new things they have learnt about themselves. (Suitable for situations where participants know each other well).

Seed Mixture : Participants take some nuts and seeds (edible) and walk around the room giving and taking a nut from other participants they introduce themselves and know about the other person as they exchange the nuts.

EXPECTED OUTCOMES : Group building, ice breaker, participant and organisation introduction, initiation of networking. Gathering expectations for the training from participants could follow this activity.

30

THEME : Stock taking context setting Participants to explore their own understanding and experience of disability. SPECIFIC OBJECTIVES :

• To facilitate initiation of thinking process among participants. • To sensitise participants towards issues of disability.

• To highlight the attitude of society towards people with disabilities.

METHODOLOGY :The main focus of this workshop is to change attitudes and therefore an important aspect is to initiate introspection and reflection into each participant's own experiences and concepts. It is critical for participants to focus on revisiting their attitudes, experiences and perceptions about the subject.

Two key outcomes are relevant here. The participants here in fact represent society and the social attitudes towards people with disabilities and therefore their attitudes, knowledge or lack of it mirror the situation 'out there' in society.

Participants need to understand their own attitudes and review their understanding of people with disabilities, and revisit their experiences to identify the relevance and need for such an orientation program. This is critical for their engagement in the whole orientation programme.

ACTIVITY SUGGESTIONS : Self-exploration and reflection to be facilitated through open ended questions, through which the participants can share their personal feelings and experiences in relation to disability.

1. An open question asked to the participants: “what feelings are generated in you about a person with disability?” Responses collated on a chart. All participants should be urged to share their feelings.

Alternative : Show a video clip of people with disabilities or a picture of a child with disabilities or narrate a short case description and pose the following questions:

• What feelings are generated as you see or hear about this child with disability?• Can you tell us about an experience of first encounter with disability? • Did you have any person with disabilities at school, your neighborhood, college, at work?• Do you know anyone with disabilities in your family or relatives?

Expected outcomes :Participants share their feelings and experiences and a lot of information comes out that can be synthesised as a summary of the situation, image and challenges faced by people with disabilities, as well as of the attitudes of participants.

This session is expected to help participants focus and warm up to the issue of disability and identify their own gaps or doubts about this subject.

SESSION-2 : INTRODUCTION TO DISABILITY

31

THEME : Types and causes of disabilities (special emphasis on recognizing mental illness and intellectual disability as disabilities as well). Differentiation of impairment, disability (activity limitation) and handicap (participation restriction). Relationship between ability, disability and the environment.

SPECIFIC OBJECTIVES : To develop a common understanding of the existing definitions and meaning of disability and share an overview of the disability scenario.

METHODOLOGY : This session relies on lot of information sharing but can be made interesting by making it interactive asking for participant's responses on types of disabilities and debriefing with a factual presentation or through use of charts. Use of pictures and slides can reinforce the concepts.

Causes of disabilities should be presented with a view to highlight the link between disability causation with lack of development (poverty, lack of information and access to services) and the possibilities of prevention and rehabilitation through accessing available systems but also through involvement in development. Case studies or examples can be utilized to explain differences between impairment, disability and rehabilitation. The aim is to clarify and align participants' concepts not just information download the presentation must be very basic, non- technical, avoiding jargon.

ACTIVITY SUGGESTIONS :Presentation of the fact, case studies and slide shows, Information about definitions, types and causes are available in literature on WHO website and ICF guidelines. Information about the PWD Act, 1995 is also available on the ministry's website. (Refer annexure for list of websites)

EXPECTED OUTCOMES :Concept alignment for participants, clarity on various types of disability and its link with environment, recognition of different kinds of disabilities like mental illness, intellectual disability, orientation to preventability of disability and introduction to disability, handicap situation and development linkage. It establishes the differences between ICF classifications of stages like: Impairment-Disability-Handicap.

SESSION 3 - BUILDING RELATIONS - KNOWING THE SUBJECT BETTER

32

THEME : Experiencing disability.

SPECIFIC OBJECTIVES : • To sensitise the participants to the barriers faced by people with disabilities.• To understand needs, problem and abilities of people with disabilities. • To develop positive attitudes towards people with disabilities.

SESSION 4 - PERSONALISING EXPERIENCE- SIMULATION

ALTERNATIVE : THEME : Barrier free Environment.

Participants are divided in four groups and assigned the task of listing barriers in the built environment for people with visual impairment, locomotor impairment and hearing impairment in school, home, outdoor (shops & leisure) and transportation.

SPECIFIC OBJECTIVES : • To orient participants with physical barriers in the built environment in context of specific needs

of different types of disabilities.

METHODOLOGY : Simulation helps participants experience, explore and relate to the needs of people with disabilities. It involves participants experiencing the difficulties that a person with disabilities may face in everyday activities and in interaction with society.

Participants carry out simple tasks manageable in a short time in their temporary disability situation. Set up fellow participants as assistants, observers or supervisors and give them the responsibility of assisting them when asked to do so or to ensure safety of the participants.

Logistics are important analyse the training environment for opportunities and borrow mobility equipment from a CBR or rehabilitation organisation beforehand. Encourage the participants to experience other disabilities be in wheelchair, use blindfolds or use walking frames or crutches during lunch break or at other opportunities.

33

Groups can then be divided in terms of disability type (locomotor, visual, communication) where they bring together their observations and analysis. This is then presented to the other groups.

ACTIVITY SUGGESTIONS :The objective of this session can be achieved through use of blindfolds (simulate blindness), use of mobility aids with legs strapped together with bandage or straps (simulate amputation/ locomotor disability), taping the fingers/thick gloves or strapping an arm with a crepe bandage (simulate leprosy, amputation or hemiplegia) and application of headphones and following instructions like, no use of speech (simulate hearing/communication disability). Other disabilities like mental illness, multiple disabilities or learning disabilities should be included in discussions and not ignored.

The participants are given a specific task an everyday routine task for example using the toilet, changing shirt/shoes, using the public phone, paying somebody (handling money), buying something from the shop outside, getting a drink, having lunch, reading/handling a newspaper, seeking information from others or expressing their own messages without speech.

Participants then discuss their observation and experiences in their group and present to a larger group later. The groups could be organised according to disability types (locomotor, visual, speech and hearing) and discussion themes may include:

• How did it feel to be a disabled person?• What difficulties did you experience while performing the task?• What difficulties did you feel as an observer or assistant? (For observers' group).• What difficulties might a person with disabilities face in everyday life ?• What might a person with a disability expect from the society?

Debrief of group presentations can include sharing the actual situation of people with disabilities from relevant reliable sources like census data, National Sample Survey Organisation (NSSO), etc for example: number of people with disabilities, number of children with disabilities who are getting education, number of people with disabilities who have employment, etc.

34

EXPECTED OUTCOMES :This methodology has been found to be most imaginative and effective if planned well. Simulation promotes participation, engagement and exploration of the concept by the participants in the best manner beyond verbal discussions.

Understanding of personal difficulties, abilities in spite of disability (potential), social and environmental barriers are the key outcomes of such presentations. It reduces the distance between disabled and non-disabled people and helps in acceptance of the relevant issues.

35

THEME : Interaction with people with disabilities on their needs, problems, strengths and attitudes.

SPECIFIC OBJECTIVES : • To develop a clear concept and knowledge about the disability• To understand the relation between causes and effect of disability• To facilitate direct interaction between participants and person with disabilities

representatives.• To develop better understanding of people with disabilities situation, needs, problems,

rights and lives.

METHODOLOGY: Dialogue and interaction with people with disabilities facilitate in clarifying the doubts of participants.

Alternatively films and/or video docu-fictions depicting positive images of people with disabilities may also be used for the purpose of discussion and perspective building.

ACTIVITY SUGGESTIONS :Disabled representatives from the local area could be invited to share their experiences and to answer any queries or doubts in the minds of participants. It's important to invite a mix group of persons with different disabilities (e.g. physical, visual, speech, hearing and intellectual). If possible invite a child with disability with his/her parents, create an informal atmosphere of discussion and encourage participants to ask questions to these representatives. EXPECTED OUTCOMES :This session is aimed at breaking stereotypes and making participants feel comfortable in interacting with people with disabilities. The representatives may present information about their personal development studies, work and social interaction. A typical participant response in a session is that participants are often not clear regarding how to interact with person with disabilities; to help or not, how much to help and so on. A general view proposed is that society is not ignorant but not sure how to interact meaningfully with disabled person. This session also reinforces the abilities in people despite their disabilities.

Caution: Very personal and intrusive questions need to be avoided, the panel of representatives need a good briefing to deal with such situations and be assertive about their own rights and dignity. The role of moderator is to ensure that sensitive issues should not violate any one's right to personal space, dignity or ease.

SESSION-5 : A DIALOGUE

36

THEME: To understand the situation of people with disabilities, focus should be on the role of the built environment and negative attitudes in perpetuation of handicap.

SPECIFIC OBJECTIVES : To initiate thinking process amongst participants towards the problems of people with disabilities &attitudinal barriers that exists in society. To orient participants with different personal and environmental factors leading to disability. To provide opportunity to build the link between disability issues with their own experiences.To broaden the participants' perspective from viewing disability as an individual issue to recognisingthe role of the built environment and attitudes.

METHODOLOGY : This can be done in many ways through presentation of the models, discussion of facts and figures or through a case study presentation. Group discussion and collective analysis of the case situation can facilitate learning of the participants in this area. The Kamla case story is mentioned here for reference.

ACTIVITY SUGGESTIONS :Presentation of case study as mentioned below followed by group discussion and presentations. (see below). The impact of the physical and social environment on disability and handicap insensitive social attitude may aggravate the handicap creation process.

The specific case study below can be copied and shared with the participants. Participants then discuss in small groups and deliberate on the following questions:

What are the main problems faced by Kamla?What are the reasons for those problems?Are the problems due to Kamla's personal limitations or due to the environment physical or social?What factors could have changed Kamla's situation?

A conclusion of this session can be done by sharing facts and figures on the situation of people with disabilities in the country,

EXPECTED OUTCOMES : Participants recognise the role of environmental barriers, negative social attitudes and lack of awareness and information as key issues; that Disability is a social issue; that exclusion that is enforced on top of personal limitations is the result of the environment and social attitudes.

•

•••

••••

SESSION 6: HANDICAP CREATION PROCESS - RELATING TO THE REALITY

37

This story is of Kamla, a 17 year old girl from Pipalaiya village of Gujarat. Raju and Suresh are her two younger brothers. Her parents work on the farm land in the village. Kamla was one year old when she got affected by polio. Seventeen years have passed since, but for Kamla it is like 70 years; why? Read on…

"Hey look at the cripple! Look at her walk…how she is moving ““shssh! Don't talk like this, she will feel bad.”

“Why should she feel bad? I am just narrating the truth. Did I say anything wrong? "

Kamla silently kept walking, she wanted to look back and reply but she kept silent. By now she was used to listening to such remarks.

She does not even remember how small she was when she got affected by polio. But she clearly remembers the day when Nurseben (nurse) came and informed her mother “Kamla now will never be able to walk like other children of the village”. She had even scolded Kamla's mother saying- “If you would have administered polio doses timely then today she would not have been in this condition”.

Kamla often used to wonder- why her mother had not paid attention to Nurse Ben's instructions. She thought her mother did not love her and did not bother. She often thought that if her mother cared, she would send her to school with Suresh and Raju and even take her out with them. One day with great courage Kamla asked her mother, “Mother why is my leg like this?” but her mother scolded her and started grumbling:

“You are not the only one, I have to send Raju and Suresh to school…And your father's health is also not proper and I have to go for work.

Just think for a moment, if the same thing would have happened with Raju or Suresh.., who would have earned for us in our old age?

And I never knew that not giving this vaccination would have led to all this. I feel that in our last birth we must have committed sins and this is the punishment.”

Kamla never ever dared to discuss this again. She wished to go to school like her brothers but she never had the courage to request her father. Whenever she tried studying her father used to scold her:

“As it is, it will be very difficult to find a match for you and if you will get educated then it will be all the more difficult”.

However, she used to open Raju's books and see pictures; when alone, she would question herself- why does father gets angry with me? What have I done? All that I desire is to be able to run with my friend Meena. I am growing taller and my crutches are becoming smaller and smaller and they are broken also. No body has time to go to the city and get me another pair of crutches. One day she asked her mother for a new pair of crutches. Her mother replied:

“You already have crutches then why do you complain?” Your walk is not going to improve even with a new pair of crutches.”

CASE STUDY : KAMLA KI KAHANI

38

It had been long since Meena (her only friend) came to meet her. Whenever they met, Kamla would be very happy as Meena would tell her all about the village and the school. If Meena went to watch amovie in the village then she would share the story with Kamla. She was the one who told about Reema who was also affected with polio. The difference was that Reema resided in a city, she had little education and now she was working in a small factory. Whenever, Kamla thought of Reema,many questions would come up in her mind:

“Will I ever be able to work?” “Will my mother and father ever help me to realise my dreams?”

Many more such questions would arise in her mind, but probably she had answer for none….

39

SESSION 7: THE APPROACHES

THEME : Models and approaches in rehabilitation SPECIFIC OBJECTIVES :

• To develop an understanding about rehabilitation processes• To develop an understanding on disability from the development perspective and the barriers to

be addressed while rehabilitating people with disabilities.• To understand models (Charity, Medical and Social) and RBA for rehabilitation

METHODOLOGY : Presentations, discussion and group exercises.

ACTIVITY SUGGESTIONS : Presentation and discussion on rehabilitation beyond the medical perspective also needs to address educational, economic and social rehabilitation. Sharing and discussion on traditional models of disability: charity model, medical model and the social model of disability and rights based model (reference Chapter 1 - section on disability and rehabilitation).

EXPECTED OUTCOME : Rehabilitation is viewed as a holistic approach to promote all aspects of development and reintegration in education, employment and social and political participation.

40

THEME : Vulnerabilities and social exclusion. Needs analysis, vulnerability and its different forms, women with disabilities, stakeholders' analysis and strategic intervention.

SPECIFIC OBJECTIVES : • To develop an understanding about vulnerabilities and their types.• To develop an understanding on various stakeholders and their roles in advocacy and

mainstreaming disabilities. • To understand the need of people with disabilities and its comparative analysis with general

human needs. • To understand problems of women with disabilities.

METHODOLOGY: A discussion and analysis of vulnerability and the needs of people in a situation of vulnerability. Comparison of this analysis with the needs of people with disabilities to identify similarities. This can be achieved by brainstorming or group presentations. The aim is to identify the real needs of persons with disability and compare them with the needs of any other vulnerable group or for that matter any other human beings.

ACTIVITY SUGGESTIONS :Groups are formed where participants working in similar development field are invited to join the discussion, for example groups dealing with child rights, income generation, self help, etc. They then discuss the needs of their client groups. The groups present their analysis and the needs are listed on a board/ flip chart.

The participants are then asked to relate to these needs to the needs of people with disabilities and to highlight the similarities. For example :

• Do people with disabilities need economic independence? • Do people with disabilities need social participation? • Do people with disabilities need education, water, sanitation, advocacy, governance, rights

awareness, information about services or sports, entertainment, family, spouse, marriage etc.?

ALTERNATIVE: Doll and Pulley : Set up - A doll is attached to one end of a piece of rope, the rope is put over a pulley and the other end of the rope has an empty basket. The doll is on the floor because of its weight next to the pulley contraption are some blank cards and some pens.

Instructions : A brainstorming session with lead questions enhances-participatory situation, need, stakeholders' and strategic analysis. The contraption represents the state of vulnerabilities a woman with vulnerability, way down on the social balance. Participants are asked to write what can be done for her empowerment, actions that will grant her equality and dignity. Participants write these actions on the cards and gradually the doll gets lifted from the floor. The needs can then be related to the situation of people with disabilities and the actions required for their upliftment.

41

SESSION 8: VULNERABILITY ANALYSIS

ALTERNATIVE : Change the negative cycle of handicap into a positive cycle or change the medical/welfare model of disability to a social model. If participants are made aware of the negative cycle of disability then they can change it into a positive model. Ask questions like what should be done to change this? (Change attitudes of society; facilitate easy access to resources, poverty alleviation and opportunities for development).

EXPECTED OUTCOMES :Participants confirm that disability is a crosscutting issue and the areas they work in is as applicable to people and children with disabilities. Needs of children with disabilities and their families are the same as the needs of other children with vulnerability. People with disabilities are excluded from mainstream development activities. Everyone will have to play their role more effectively. Strategy must be empowering people with disabilities by their involvement. Action must start immediately.

42

SESSION 9 : WHAT DOES THE LAW AND CONVENTION SAY?

THEME : Understanding the PWD Act, 1995, the Biwako Millennium Framework, the UNUDHR, the UNCRC and the UNCRPD. SPECIFIC OBJECTIVES :

• To orient participants on Acts, Programs, Schemes and Policies related to people with disabilities in country.

• To develop an insight about UN Convention and Biwako Millennium Framework.• To sensitize about the relationship between discrimination, poverty, gender, exclusion, rights,

governance and disabilities.

METHODOLOGY: The participants can now relate to the common needs of any vulnerable group and realize the need to include people with disabilities in their organisational activities. Since rights are a key driving force for most development programs this session is geared towards highlighting the rights of people with disabilities.

ACTIVITY SUGGESTIONS :Collective reading - Smaller groups are given different chapters of:

• The Persons with Disabilities (Equal Opportunities, Protection of Rights and Full Participation) Act, 1995

• The Biwako Millennium Framework• The United Nations Universal Declaration of Human Rights 1948• The United Nations Convention on the Rights of Disabled Persons• The United Nations Convention on the Rights of the Child, etc. and the group present their

understandings to the group.

Presentations followed by discussion, dissemination of leaflets or booklets as reference material. (Reference the documents can be found on the government website)

EXPECTED OUTCOMES :Benefits and special provisions for people with disabilities are discussed that could be useful in mainstreaming disability into development activities. Rights and advocacy, rather than charity, is confirmed as the basis of inclusion of disabled people in development.

43

THEME : Introduce the concept of inclusion and highlight some of the models and practices.

SPECIFIC OBJECTIVES : • To orient participants with inclusive education and employment.• To share some of the field experiences of a holistic, inclusive and rights based approach for

inclusion of people with disabilities. • To familiarise participants with some replicable models of inclusion.

METHODOLOGY : Participants can now be oriented to some of the concepts of inclusion inclusive education, inclusive employment, a barrier free environment, etc. These could be presentations or narration of some case studies or video films. Manuals and posters are available from various organisations that describe the practices. (The tools can also be made available from UNNATI, Organisation for Development Education, Ahmedabad, Gujarat and Handicap International office)

ACTIVITY SUGGESTIONS : Presentation/narration/discussion of :

• Community Based Rehabilitation• Inclusive Education• Inclusive Employment• Inclusive Income Generating Activities• Inclusive decision making and Inclusive Organisations• Barrier Free Environment-crucial step for inclusion• Social Awareness tools

Using the information provided in “The Experience” section of this chapter as a guide.

EXPECTED OUTCOME : Participants become aware about the possibilities of implementation through these models. Best practices are shared with participants, which confirm the applicability of the models and approaches.

SESSION 10 : MODELS OF INCLUSION

44

THEME : Consolidation of learning: sharing of significant learning as individuals, group and organisations. SPECIFIC OBJECTIVES :

• To provide opportunity to participants to consolidate their learning individually and in the group.

METHODOLOGY : Group discussion and presentations on their key learning. Participants discuss and note key points and present a summary of their discussions using flip charts.

ACTIVITY SUGGESTIONS : Discussions within groups on their key learning and their perceptions of priorities and possible directions for action. The guiding questions for the discussion are:

• List down your key learning in the workshop.• What is the relevance of these learning with the role you play as an individual, a professional and

within your organisation?

EXPECTED OUTCOMES : Consolidation of learning, alignment of participant's perceptions, reinforcing the need for inclusion of disabled persons within any activity and that inclusion needs reorientation of attitudes before being a resource led change.

SESSION 11 : PUTTING THE PARTS TOGETHER

45

THEME : Drawing out a plan for an inclusive society and creative expression of the same.

SPECIFIC OBJECTIVES : • To facilitate process with participants to draw out plan of action on the basis of learning during

the workshop.

METHODOLOGY : Participants are divided into groups of similar work areas (Income Generation, SHGs, rehabilitation, women, advocacy and rights etc). Discussion within groups is followed by presentations of a plan.

ACTIVITY SUGGESTIONS : Participants discuss what they can and will do to take this movement forward. They develop intervention plans and the possible directions they can take as individuals, as representatives of an organisation or as a member of civil society. The plans are then presented to the rest of the group. They should also be asked to identify what resources or support they might require for this and where are they likely to get it.

EXPECTED OUTCOMES : Participants identify and develop intervention plans. They also identify the resources within their area and how they could support or get supported by others. The resource sharing and networking needs are reinforced. Overlapping and duplication can be foreseen and priorities for joint action can be identified. CLOSING SESSION : Commitment to walk together.Close the session formally with the commitment from different stakeholders and agree on continued follow-up arrangements.

SESSION 12 : PATH FORWARD

146

In this chapter, the effort has been made towards offering simple explanations of various concepts of mainstreaming, on the basis of experiences of Handicap International. These are on the basis of successful stories of implementation of disability inclusion models. This also provides opportunities to reader to orient themselves to the models which are possible and replicable with appropriate modifications in relation to the context and the need.

CHAPTER FOUR

THE EXPERIENCE

CBR began with the objective of providing basic rehabilitation services to people with disabilities within their communities, by utilising community resources. Local volunteers were trained to provide basic rehabilitation advice, locally crafted assistive devices and referral services to specialist services. A grass root worker could organise an adapted chair, splints and/or equipment for therapy with the help of a local craftsman, offer basic rehabilitation programs to parents and monitor person with disability within their homes. S/he could always refer people for advice and consultation at the specialist hospital or for an outreach camp and follow up.

While this did facilitate identification of people with disabilities and availability of basic rehabilitation advice at the community level, it did little to change people's attitudes to disability or increase opportunities for them.

Comprehensive CBR works at two levels rehabilitation and inclusion. A CBR worker continues to support rehabilitation needs of a person with disabilities; at the same time s/he works on facilitating access to services and schemes (e.g. bus pass, grants and loans), inclusion of people with disabilities within communities; for example facilitating inclusion of a child with a disability to school, an adult to a local income generating activity, and s/he uses tools for social communication to promote awareness and thus participation of people in rehabilitation. Comprehensive CBR is a holistic approach where individual and social changes are focused and developed.

COMPREHENSIVE COMMUNITY BASED REHABILITATION

147

INCLUSIVE EMPLOYMENT

Initial opportunities for employment of people with disabilities were only in special setups run by some NGOs and governments, and were classed as 'sheltered workshops'. The potential of a person with disabilities to work was undeveloped, and only basic tasks and assembly operations were considered suitable for them. The sector and scope of employment have since widened and now some other areas have been identified. In India, Subscriber Trunk Dialling (STD) phone booths, Mother Dairy outlets, and telephone exchange jobs have opened up new possibilities beyond spice grinding and candle, incense and greeting cards making. The Indian Government has set up reservations in various categories of jobs specifically for people with disabilities. All these are special arrangements. In India, the corporate world still falls behind in their commitment to this cause and when people with disabilities are employed in the corporate sector, this is sometimes based on charitable motives rather than a belief in the disabled persons' equal potential. The training of people with disabilities in technical areas is still often delivered in a sheltered setting.

Inclusive employment involves mainstreaming of disabled people into the regular employment sector through training and in service grooming. It focuses on skill development in mainstream training locations

48

INCLUSIVE EDUCATION

Education is a fundamental right. For a disabled person, social attitudes, environmental barriers and personal limitations make access to school a complex challenge. Initially this basic right was denied to many children with disabilities; and the only option available was admission into special schools, for example for children with polio related disability, children with multiple disabilities and children with intellectual disabilities. Gradually, more and more schools adopted the welfare approach and set up a part of their facility for children with disabilities. Here, specially trained teachers from specialist centres were engaged to teach/train them in special classes within the confines of a mainstream school. Now the situation is again in transition where some children with disabilities are part of a regular classroom, and a specially trained teacher supports the class teacher to teach them. These special teachers complement the regular teaching with additional support to children with disabilities, and set up special equipment or tools to aid the child's learning process. Although this has facilitated opportunities for some children with disabilities and is known as 'integrated education', it still promotes the perception that children with disabilities have special needs.

Inclusive education is a concept that promotes development of an environment where all children receive the same opportunities, teachers incorporate an activity based approach, different training methods are used, to cater to all needs and senses of a child; and therefore create a richer medium of learning. Peer support is set up where children develop sensitivity and complement each other. Whereas this facilitates the development of a child with disabilities, it also contributes to shaping positive attitudes of all non-disabled persons around that child and therefore creates an inclusive civil society. Accessibility is not seen as a special need for some but is considered as a “universal design” for all children, and audio visual sensory tools are not seen as special learning tools for some but as general tools and methods that benefit all.

Many income generating activities are conducted by SHGs in their local area. Their objective is to promote development, self reliance and poverty alleviation. These activities are organized and developed for and with various vulnerable groups. As discussed earlier, people with disabilities have the same needs as others and in fact all groups where these income generating activities are setup for the benefit of vulnerable people will also enhance the lives of people with disabilities. An inclusive income generating program will include a person with disabilities or their family members. A mother of a child with disability could be part of income generating programme for a women's group. Inclusive income generating activities promote access to and dissemination of information and resources reserved for people with disabilities. They involve participation of people with disabilities in decision making and planning of income generating activities.

INCLUSIVE INCOME GENERATION ACTIVITIES

Inclusive decision making involves people with disabilities or their representatives, just as any other crosscutting vulnerable groups, for example women. Representation and participation of people with disabilities is relevant in all areas of development, whether it is disaster preparedness, water and sanitation services, urban planning, social activities or voting and political participation. This involvement further promotes inclusion and equal and full participation.

At another level, organisations can ensure protection of the rights of people with disabilities by promoting opportunities and removing barriers. By including the needs of disabled people in their planning, for example for social communication, care would be taken to include disability prevention and the development of potential of people with disabilities in communication tools. If they deal with advocacy they would include advocacy for the rights of disabled people in their activities. If they deal with media advocacy they would try to sensitise media about disability as a social cause and facilitate media to promote coverage of disability issues in newspaper and advocate for the rights and positive image building of people with disabilities. Inclusive organisations will recruit people with disabilities and offer equal opportunities to them in their organisational activities, at all levels: activity, management and strategic. These organisations would also be able to create barrier free work spaces.

INCLUSIVE DECISION MAKING AND INCLUSIVE ORGANISATIONS

49

and providing opportunities to people with disabilities in all areas of training and placement. An inclusive employer recognises the potential of a person with disabilities, provides to him or her, an appropriate barrier free environment which is comfortable for other staff too and allows opportunities for them to develop their abilities in a stimulating and challenging environment. Above all s/he provides a level playing field and starts recruiting people with disabilities to reserved jobs.

“Disability and Development a practical approach to inclusion in India”, is presented on the basis of the experiences of Handicap International in Gujarat. This approach has been used for influencing, promoting and model-building towards mainstreaming disability into development. The approach has been instrumental in building capacities of various stakeholders through disability sensitisation, the first step in the process of including people with disabilities into development activities.

In our experience almost all the stakeholders have agreed that urgent and necessary action needs to be taken up to include people with disabilities in all the development activities. However, understanding their own role in the process and how they could practically contribute towards integrating disability was one common difficulty they all experienced. Many stakeholders were unaware before this interaction, if they had any roles at all. The training module developed during these two years created this unique opportunity, through participatory methodologies, for the participating partners to review their strategies, understand their crucial role and eventually include disability into their existing mandate.

Handicap International continues to use this approach with more and more partners in Gujarat such as: Department of Health and Family Welfare (DoHFW), Government of Gujarat (GoG), Ahmedabad Study Action Group (ASAG), Gram Vikas Seva Trust (GVST), Idar, SAATH Charitable Trust, Ahmedabad, Vikas Centre for Development, Ahmedabad, Disability Advocacy Group (DAG), Gujarat. We also successfully adapted it across India with other partners such as CARE India, Save the Children Fund (SCF), Action Aid in Andaman and Nicobar Islands, Access Resource Group (ARG) in Delhi. In partnership with the above mentioned organisations, we are working to mainstream disability into the public health system, microfinance activities, community based disaster preparedness plans, and livelihood activities. After four years, it is now a proven cost effective methodology that can be adapted to the specificities of many development activities with minor modifications.

Handicap International's vision is that development organisations, (both government and non-government), disability organisations, support organisations, consultants, community based organisations, professionals and individuals can modify the training modules to suit their needs and empower more and more individuals and organisations to include people with disabilities. Additional relevant training materials are available from the Handicap International office in Gujarat.

We have pleasure in announcing that this publication is also available in electronic format and can be made available in large print on request. There are contact details at the end and we welcome your suggestions, feedback and experiences.

THE CONCLUSION

50

ANNEXURE

I. UNNATI UNNATI - Organisation for Development Education works in Gujarat and Rajasthan focusing on the issues of social exclusion and vulnerability reduction. UNNATI fights discrimination caused on the basis of class, caste, religion, gender, minority and now disability. UNNATI's association with Handicap International started with a wish to broaden the definition of social exclusion, include disability in the list of targeted vulnerabilities and experiment with mainstreaming disability into development processes.

TRAINING MODIFICATION A three day perspective building workshop was conducted for the staff of UNNATI, mainly focusing on understanding disability from the development perspective. Simulation, models and approaches of rehabilitation and the handicap creation process were some of the issues focused on during this session. The reflection exercises focused on civil society's role in creating and removing barriers.

OUTCOMESThe first step undertaken by UNNATI was to create a barrier free environment in their office premises and appoint people with disabilities in the team. This provided an opportunity for better interaction and understanding amongst members of the team. Similar perspective building programs on disability and development were held with different stakeholders. Several community development organisations and mainstream development organisations in project districts of Gujarat and also in Maharashtra have been part of this process.

Besides, UNNATI has now taken a lead in experimenting with the initiative for mainstreaming disability and undertook various activities to enhance the role of the civil society towards inclusion of disability. The changes that occurred within UNNATI were far more enriching and sustainable. Their lists of social exclusion now also include people with disabilities, making it much more comprehensive. Their strength is the capacity building programs for different stakeholders and also developing social communication tools. The social communication tools developed by UNNATI include people with disabilities. The communication tools produced now are gender as well as disability sensitive. The advocacy program with local governance highlights the role of people with disabilities also. The disaster preparedness program includes plans from disability perspective also. UNNATI is a model which reinforces the belief that mainstreaming of people with disabilities is possible and in fact is a MUST.

CASE STUDIES

51

II. SEWA BankMAHILA SEWA CO-OPERATIVE BANK was established by a group of self-employed women in 1972 when the Self Employed Women's Association (SEWA) was registered as a trade union in Gujarat, with the main objective of "strengthening its members' bargaining power to improve income, employment and access to social security”. SEWA has an all India membership of over 2,50,000. In May 1974, the SEWA Bank was registered as a co-operative bank under the dual control of The Reserve Bank of India and the State Government. Since then it has been providing banking services to poor, illiterate self-employed women and has become a viable financial venture.People with disabilities have not been mainstreamed in these activities for various reasons. Providing access to services for people with disabilities will enable these institutions to tap into a large market at the same time providing much needed financial services to people with disabilities.

TRAINING MODIFICATIONThe implementing professionals and grass root staff in SEWA Bank required sensitization/capacity building to enable themselves to address disability as a cross-cutting issue. A workshop on “Disability and Development an approach towards inclusion of Disability in micro finance processes” was conducted for staff of SEWA Bank in August 2005, focusing on an exploration of the feasibility of mainstreaming disability into the existing program, which focuses on economic development of self employed women.

The workshop highlighted to participants the links between issues such as poverty, vulnerability and need analysis. Emphasis on the situation of women with disabilities was critical towards realization for an inclusive approach, and equal opportunities for women with disabilities according to their constitutional and fundamental rights.

The participants of this workshop ranged from the levels of community mobiliser to program manager and executive director, and thus the workshop content focused on feelings, attitudes and information related to the issue of disability. The productive abilities of people with disabilities were highlighted through films and case stories which were reassuring for this group and served to reinforce the belief that there is a need for economic integration for people with disabilities.

OUTCOMESParticipants departed with plans to reach out to WWDs in their project areas. SEWA Bank continues to make efforts towards integrating disability across all existing programs.

52

III.SAVE THE CHILDREN FUND (SCF) UKSave the Children Fund (SCF) UK focuses on ensuring human rights of all children irrespective of class, caste, colour, age, religion and gender. The emphasis is on promotion of child participation towards fulfilment of the rights of children.

TRAINING MODIFICATIONS A sensitization and orientation workshop 'Perspective building on disability and development' was organised for SCF staff and partner organisations to mainly facilitate integration of disability as a cross-cutting issue in SCF, in addition to gender, citizenship and the private sector and was conducted in Jaipur in January 2005. The workshop was attended by senior management staff, program and project co-ordinators and other concerned staff of SCF or it's partner organisations.

The highlight of this workshop was the focus on the human rights of children, understanding of the UNCRC from the disability perspective. The other areas of focus were rehabilitation models, the handicap creation process and attitudinal barriers and their impact on the denial of rights to children. Physical barriers and accessibility features in schools were also highlighted. The session on inclusive education and inclusive environments within schools was one of the most appreciated sessions in this workshop.

OUTCOMES: The workshop was facilitated by Handicap International with co-facilitation by Mini Bhaskar, SCF. Participants were supported to create a plan for short and long term interventions on the basis of their learning and in the context of their present work situations. Highlights of their future plans ranged from identifying CWDs and people with disabilities to awareness, advocacy and inclusion in education, self-help groups, family support and referral services.

One common suggestion from the group was that they would like to take back their learning for further discussion and make decisions within their teams and committees to plan how to orient more people to the needs, rights and abilities of disabled people.

IV.MEDIA SENSITIZATION AND ADVOCACY In order to influence media professionals towards inclusion of people with disabilities, the following steps were taken:

• Identification and orientation of local journalists and other national-level journalists who focuson development issues in disability issues.

• Sensitisation workshops were taken up in 3 districts for 60 + media persons focusing on disability as a development issue. The positive images and needs, rights and abilities of people with disabilities were highlighted. These workshops also facilitated interaction of media personnel with people withdisabilities.

• Media persons were supported with information, case stories and linkages.

OUTCOMESAs a result more than 60 articles regarding disability have been published in daily and periodical publications, including articles on accessibility in leading journals of architecture. A year long programme of 52 episodes on Ahmedabad radio focusing on disability issues was implemented. Event based coverage and interviews of people with disabilities on TV, advocating for their rights has also occurred.

53

CHARKHA, a development communication network has begun to integrate disability issues and people with disabilities in all ongoing activities.

Disability issues have found their space in general columns in newspapers and frequency of coverage and awareness on disability issues has increased.

Disability issues have also been integrated into media programmes developed by UNNATI governance team.

V. PEOPLE WITH DISABILITIES AND DISABLED PEOPLE'S ORGANISATIONS (PWD DPO)Handicap International in collaboration with local DPO's (Shri Yuva Viklaang Mandal, (SYVM), Kachchh and Shri Yuva Vikas Mandal, Sabarkantha) organized workshops for representatives of people with disabilities from different districts of Gujarat. This was in continuation with the series of workshops that were conducted for different stakeholders on Disability and Development within Gujarat. People with disabilities being one of the key stakeholders in creation of an inclusive society, these workshops provided an opportunity for strengthening their capacities and viewing their role in this direction analytically.

The workshop aimed to orient the participants on disability as a development issue and strengthen their capacities for awareness and advocacy towards inclusion of people with disabilities in mainstream development processes. The workshop module had an important focus on leadership, motivation, self growth and development to enable participants in performing a new envisaged role.

Eighty eight representatives of 23 districts of Gujarat participated in 3 days workshop on perspective building on disability and development awareness and advocacy towards inclusion of people with disabilities in Nov 2005 in Gujarat.

Nakumbhai from Rajkot said “We could all learn in an inclusive environment in last three days here.. why can't we have similar environment in society as well, if it is possible here it is possible everywhere…”

The information related to disability initiatives locally, nationally, globally proved to be motivational for the participants, they learnt from each other. The participatory methodology of the workshop reinforced the fact that people with disabilities have an important role to play and they can be key players in brining change.

Participants left the training with a feeling of self worth and with better understanding of their role in awareness and advocacy towards inclusion. The air is fresh and positive back home and we have been receiving stories Too general of their proactive initiatives in interaction with different stakeholders in society.

54

VI. NATIONAL INSTITUTE OF DESIGN (NID) PROFESSIONAL COMMUNICATIONThroughout the collaborative efforts of Handicap International and the Department of Health and Family Welfare (DoHFW), Government of Gujarat, it was felt that community based rehabilitation programmes should increasingly challenge and support the health authorities to improve the competence and capacity of primary health care and to engage with community based organisations to increase their knowledge and awareness on issues of disabilities. In response a project entitled “Early Identification and Intervention for the Prevention of Disability and its Complications”, covering nine districts of Gujarat, is being implemented.

Awareness building has been identified as one of the most critical requirements for appropriate early identification, prevention and intervention in disability. Developing an appropriate communication strategy in order to reach in the community in the project areas is one of the key interventions of the project.

27The National Institute of Design (NID) has been involved in helping the project to develop a communication strategy to eventually influence the role of relevant stakeholders towards inclusion of people with disabilities. For the first phase, involving field based research with the objective of understanding the grassroots situation, NID collaborated with Centre of Development Communication (CDC), Gujarat University to undertake research across the project area. Postgraduate students of the CDC (first and second year) were involved in the field work as a part of their academic work. In this context, it was imperative to first build a common understanding of the entire team on the issue of disability and development. NID requested Handicap International to conduct a perspective building workshop to orient and sensitise the project team on recognition of disability as a development issue and to incorporate disability issues while developing communication strategies.

The workshop was conducted in October 2005 in Ahmedabad and focused on the situation of people with disabilities locally, nationally and globally. It highlighted vulnerabilities, provided an understanding of stakeholders analysis, human need analysis and human rights. The attitudes of society towards people with disabilities and messages from people with disability were also emphasised in this workshop. Positive case stories regarding people with disabilities were one of the key elements.

The workshop helped the participants in understanding the basic fundamentals of impairment disability handicap, as well as demystifying several myths. The theoretical inputs on various models of disability from a historical perspective were received very well. The inputs gave an understanding of disability and handicap and its co-relation to poverty, illiteracy and gender. Following the workshop, the team took up field base participatory research to develop a communication strategy and material for awareness-raising on prevention and early identification of disability.27The National Institute of Design (NID), Ahmedabad was set up in 1961 by the Government of India under the Ministry of Industry, as an autonomous national institution for design, education, training, service and research. NID today is recognized as a scientific and industrial research organisation by the Department of Science & Technology, Government of India. NID has a deep commitment for design intervention in socially relevant sectors such as design for people with physical and intellectual disabilities. NID has contributed significantly on design related issues in these sectors over several years. NID's Outreach Program is a dedicated wing for providing design support to several vulnerable sectors. It takes up projects, which lead to empowerment and capacity building of social sectors through skill up-gradation training, and cluster development through design intervention.

55

Biwako Millennium Framework for Action: United Nations Economic and Social Commission for Asia and the Pacific (UNESCAP) website: http://www.unescap.org/esid/psis/disability/

Community Based Rehabilitation: World Health Organisation website: http://www.who.int/disabilities/cbr/en/

United Nations Convention on the Rights of Persons with Disabilities: United Nations website: http://www.un.org/disabilities/

Handicap International website: http://www.handicap-international.fr/en/index.html?cHash=dff5803894

International Classification of Functioning: World Health Organisation website: http://www.who.int/classifications/icf/site/icftemplate.cfm

Livelihoods and people with disabilities: International Labour Organisation (ILO) website Ability-Asia: http://www.ilo.org/public/english/region/asro/bangkok/ability/index.htm

Mainstreaming and Inclusion: World Bank website:http://web.worldbank.org/WBSITE/EXTERNAL/TOPICS/EXTSOCIALPROTECTION/EXTDISABILITY/0,,contentMDK:21277815~menuPK:282718~pagePK:210058~piPK:210062~theSitePK:282699,00.html

People with Disabilities Act, 1995: Government of India website : http://www.ccdisabilities.nic.in/Act%201.htm

Resource library related to disability in developing countries: SOURCE website: http://www.asksource.info/

For further information, readers can contact :

Handicap International India, Gujarat Bungalow No.1, Panchjyot Society, Opp. Hasmukh Colony Char Rasta, Nr. Vijaynagar Petrol Pump, Naranpura,Ahmedabad-380013, Gujarat India.Tel: 0091-79-65425646, TeleFax: 0091-79-27461568Website: www.handicap-international.org

UNNATI, Organisation for Development Education G-1/200, Azad Society, Ahmedabad-380015, Gujarat, India Phone: 91- 079-26746145, 26733296, Fax: 91- 079- 26743752 Email: sie@unnati.org, Website: www.unnati.org

REFERENCES

Where to find more Information

56

Founded in 1982, Handicap International is a non-governmental organisation that works in 55 countries around the world. We work, via our projects and political action, to prevent situations of handicap and support systems and services for persons with disabilities. In doing so, we ensure equal opportunities and rights for people with disabilities. Handicap International has been supporting local initiatives in India in since1988. In 2000, we scaled up our efforts with a broader programme and geographic focus.

Handicap International supports actions towards a barrier-free and rights-based society for people with disabilities and in other vulnerable situations in India. To this end, we work with people, local and international organisations and governments who share our vision of an inclusive society, where vulnerable people have equal rights and opportunities and live with dignity, irrespective of the cause, nature and environment underlying the situation.

We know that people with disabilities have the capacity to develop the aptitude and the autonomy to fulfil their life goals. We believe that the risk factors which lead to incapacity, create or worsen vulnerability, can be reduced. We are convinced that the social and physical environment can be easily adapted to better address the needs and rights of people with disabilities. We are particularly sensitive to the issues of women with disabilities. We are committed to enhancing the inclusion of people with disabilities in all that we do, because we believe that it improves their quality of life and ours.

In 1997, we were co-winners of Noble peace prize for our political action to ban landmines.

HANDICAP INTERNATIONAL

For further information please contact :HANDICAP INTERNATIONAL1, Panchjyot Society, Opp. Hasmukh Colony Char Rasta,Vijaynagar Road, Naranpura, Ahmedabad - 380 013Tel. : 079 6542 5646 • Telefax : 079 2746 1568E-mail : prg@hi-india.org

NEW DELHI10, Zamrudpur Community Centre,Kailash Colony ExtensionNew Delhi - 110 048Tel. : 011 46566934 • Fax : 011 41646312