MODEL DISABILITY SURVEY GENERAL RESULTS ZIARAT … · for persons with disability in Pakistan. The Taraqee Foundation is a non-governmental and non-profit national level organization

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MODEL DISABILITY SURVEY

GENERAL RESULTS

ZIARAT DISTRICT, BALOCHISTAN

PROVINCE, PAKISTAN

Table of Contents 1 Introduction ....................................................................................................... 2

1.1 How does the MDS measure disability? .......................................................... 2 1.2 What were the objectives of the implementation in Baluchistan? ....................... 3

2 Core results ....................................................................................................... 4 2.1 Households ................................................................................................. 4 2.2 Demographic characteristics ......................................................................... 5 2.3 Disability .................................................................................................... 6 2.4 Most affected daily life areas ......................................................................... 8 2.5 Health ...................................................................................................... 22 2.6 Work ....................................................................................................... 24 2.7 Education ................................................................................................. 25 2.8 Environmental factors ................................................................................ 26 2.9 Health care responsiveness ......................................................................... 33 2.10 Well-Being ............................................................................................. 35

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1 Introduction The Model Disability Survey (MDS) is a survey questionnaire used to collect data about

disability in a country or country region. The MDS was developed by the World Health Organization (WHO) and the World Bank in 2012, in consultation with international

organisations, leading researchers, and DPOs.

The survey helps countries authorities, NGOs and DPOs better understand the situation of people who have disability, especially their unmet needs as well as the barriers that they

face in daily life.

Governments use the data to develop disability policies and national or regional disability

action plans that are based on the real-life situation of people who have disability. They also use the data to monitor and report on the implementation of the Convention on the Rights of Persons with Disabilities and the indicators of the Sustainable Development Goals.

NGOs and DPOs use the data to advocate for what is needed to ensure that people who have disability can enjoy their human rights fully on an equal basis with others.

1.1 How does the MDS measure disability?

The MDS takes a broad approach by measuring disability taking into account health

conditions (e.g. depression or diabetes) or impairments (e.g. vision or hearing loss) people have and the context in which they live. The context includes:

- Barriers faced in the community, for instance being able to access public spaces;

- Attitudes of others, for instance being treated with respect or considered able to work;

- Social support received, for instance having family or friends one can count on;

- Easiness of access to health care, for instance being able to see a family doctor;

- Easiness of access to assistive products of good quality, such as a cane or wheelchair;

- Laws in place that ensure rights, such the right to receive an education in regular schools.

As a result of the interaction between health conditions or impairments and the context in which a person lives, disability might be faced in daily life, including:

- impairments, such as pain, loss of cardiovascular function or loss of muscle power;

- limitations in activities, such as moving around in the neighbourhood, eating or to tidying

up oneself, and restrictions in participation in society, such as problems to work or to

participate on community activities.

The MDS approach also understands disability as a continuum that ranges from no disability to very high levels of disability, depending on the health conditions and the context of the

person. Disability is a matter of degree, and no, mild, moderate or severe levels of disability can be differentiated for policy purposes.

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The level of disability in countries and regions is influenced therefore not only by trends in health conditions and impairments but also by physical, human-built, attitudinal and socio-

political barriers or facilitators.

Natural disasters, such as long drought periods, conflict situations, such as war, or the number of traffic accidents, will affect disability levels in a population both by changing the

prevalence of impairments and by creating physical barriers.

1.2 What were the objectives of the implementation in Baluchistan?

Pakistan faces several challenges that are frequently associated with high levels of disability, such as a high prevalence of polio, insufficient maternal health care, problems with health

care accessibility, chronic poverty, frequent natural disasters, and ongoing war on terror.

Additionally, persons with severe impairments, such as paralysis or amputations, face overwhelming barriers in all aspects of life including education, livelihood, health care and

skills development, and there is a lack of adequate legislation, policies and programming for persons with disability in Pakistan.

The Taraqee Foundation is a non-governmental and non-profit national level organization working in Pakistan since 1994. It has implemented several small and large scale projects to assist marginalized communities in far flung areas of Baluchistan and other provinces of

Pakistan. The Taraqee Foundation has vast experience of working on disability in the province and specifically in the district Ziarat, where has had a partnership with the Pakistan

Poverty Alleviation Fund in the scope of disability interventions for the last decade.

The Taraqee Foundation supported a regional implementation of the MDS in the district Ziarat of Baluchistan to estimate how many people have severe, moderate and mild

disability, and to identify the unmet needs as well as the barriers and inequalities faced by these persons in daily life. The data should be used to better plan services and policies for

persons with disability and to advocate for a national data collection in Pakistan.

Therefore, the objectives of the MDS in the Ziarat District, Balochistan, Pakistan are:

1. To estimate the prevalence of disability;

2. To determine the current disability distribution of the population; 3. To identify needs, barriers and inequalities faced by persons with different levels

of disability; 4. To provide the information necessary for the development of future policy

priorities to improve the lives of the population with disability in the Ziarat

District.

The sample size was extimated using the sample size determination formula for Lorenz's

cross-sectional studies and a total minimum of 545 individual participants was set as the target sample.

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2 Core results

2.1 Households

The mean, median and range of the number of people living in the 450 participating households by age category are given in Table 1. Table 1: Basic statistics of the number of people living in each household by age category

Age group Mean (SD) Median Range

Children up to 5 0.7622 (0.99) 0 0 - 4

Children between 5 and 18 2.331 (2.15) 2 0 - 12

Adults between 19-40 years old 2.596 (1.83) 2 0 - 11

Adults between 41-60 years old 0.8711 (0.84) 1 0 - 7

Adults older than 60 years old 0.5067 (0.69) 0 0 - 3

Total persons living in the household 7.067 (2.75) 7 2 - 15

The age and gender distribution of the people living in the selected households is visualized in Figure 1. Figure 1: Age and gender distribution of the of the people living in the selected households.

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2.2 Demographic characteristics

The demographic characteristics of the sample of 450 individuals living in the Ziarat District are given in Table 2. The sample included 300 men and 150 women. While women were balanced distributed regarding age, the large majority of men (62.5%) were aged 18 to 39

years old. While almost all men were working (89%), the large majority of women didn’t work for pay (78%). The percentage of persons without any education in mucher higher in

women (82%) than in men (22.3%). Given the large sex differences in the sample, results will be presented separately for men and women. Table 2: Demographic characteristics of the sample.

Total sample Men Women

Characteristic N % N % N %

Age group (years)

18-39 233 52.5 185 62.5 48 32.4

40-59 139 31.3 84 28.4 55 37.2

>60 72 16.2 27 9.1 45 30.4

Total 444 100% 296 100% 148 100%

Work status

Not working 150 33.3 33 11 117 78

Working 300 66.7 267 89 33 22

Total 450 100% 300 100% 150 100%

Education level

No education 190 42.2 67 22.3 123 82

Elementary 17 3.8 16 5.3 1 0.7

Vocational 41 9.1 34 11.3 7 4.7

Secondary 122 27.1 117 39 5 3.3

Higher 76 16.9 64 21.3 12 8

Other 4 0.9 2 0.7 2 1.3

Total 450 100% 300 100% 150 100%

Marital status

Single 83 18.4 72 24 11 7.3

Married or legal cohabitation

318 70.7 227 75.7 91 60.7

Widowed 49 10.9 1 0.3 48 32

Total 450 100% 300 100% 150 100%

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2.3 Disability

Disability is the outcome of the interaction between health conditions or impairments and features of the physical, human-built, attitudinal and socio-political environment in which

the person lives. Disability is also understood in the survey as a continuum, ranging from very low to severe levels of disability.

Figure 2 shows the continuum of disability in Ziarat, in a metrical scale ranging from low levels of disability (zero) to very high levels (100). This figure shows that the majority of

the sample experience moderate disability. However, important sex differences are observed in Figure 3: while the proportion of men with severe disability levels (dark blue)

is very small in the distribution for males, it is very high for females. Results presented in Table 3 corroborate these observations. Figure 2: Disability continuum for the Ziarat District

Figure 3: Disability continuum for the Ziarat district by sex

Men (N=300) Women (N=150)

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Table 3 shows the proportions of the sample with mild, moderate and severe disability, for

the total sample and by sex. Results are dramatically different for men and women. The severe disability rate is 16.2% for the complete sample, coming close to the 15% global estimate of WHO. However, wenn disagreggated by sex, the rate of severe disability is very

low for men, 3.3%, and very high for women, 42%. While approximately 60% of men have no or mild disability levels, only approximately 5% of the women included in this sample

have no or mild levels of disability. Indeed, the proportion of women with moderate or severe disability amounts to approximately 95%. Due to these very large differences, all results will be presented separately for men and women.

Table 3: Absolute numbers and percentages of persons with no, mild, moderate and severe disability, by gender.


Disability level N % N % N %

No disability 51 11.3 51 17 0 0

Mild disability 136 30.2 128 42.7 8 5.3

Moderate disability 190 42.2 111 37 79 52.7

Severe disability 73 16.2 10 3.3 63 42

Total 450 100% 300 100% 150 100%

Table 4 shows the demographic characteristics of men and women by disability level.

Only 10 men (3.3%) had severe disability. This must be taken into account when interpreting results of this implementation. Comparing the 37% of men with moderate

disability to the men with no to mild disability, we observe: - No age-associated differences between the groups; - The higher the disability level, the higher the proportion of males not working;

- That males with severe disability have lower educational outcomes.

Only eight women (5.3%) had mild disability and no one had no disability. Comparing the

42% of women with severe disability to the 52.7% with moderate disability, we observe that: - Women with severe disability are older and more frequently widows;

- More women with severe disability do not work, but differences are not large; - No differences regarding education. Table 4: Demographic characteristics by disability level for men and women. No women had no

disability.

Characteristic


Disability level Disability level

No Mild Moderate Severe Mild Moderate Severe

N % N % N % N % N % N % N % Age (years) 17-39 40 78.4 83 65.9 58 53.2 4 40 6 85.7 34 43.6 8 12.7

40-59 9 17.6 35 27.8 37 33.9 3 30 0 0 29 37.2 26 41.3

>60 2 3.9 8 6.3 14 12.8 3 30 1 14.3 15 19.2 29 46

Work status

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Characteristic




N % N % N % N % N % N % N %

Not working 1 2 11 8.6 15 13.5 6 60 4 50 58 73.4 55 87.3

Working 50 98 117 91.4 96 86.5 4 40 4 50 21 26.6 8 12.7

Education

No education 10 19.6 24 18.8 29 26.1 4 40 3 37.5 65 82.3 55 87.3

Elementary 2 3.9 7 5.5 7 6.3 0 0 0 0 1 1.3 0 0

Vocational 5 9.8 9 7 18 16.2 2 20 0 0 4 5.1 3 4.8

Secondary 24 47.1 58 45.3 33 29.7 2 20 1 12.5 2 2.5 2 3.2

Higher 10 19.6 29 22.7 23 20.7 2 20 4 50 5 6.3 3 4.8

Other 0 0 1 0.8 1 0.9 0 0 0 0 2 2.5 0 0

Marital status

Single 19 37.3 29 22.7 22 19.8 2 20 2 25 2 2.5 7 11.1

Married or legal

cohabitation

32 62.7 98 76.6 89 80.2 8 80 6 75 57 72.2 28 44.4

Widowed 0 0 1 0.8 0 0 0 0 0 0 20 25.3 28 44.4

The general severe disability prevalence for Ziarat District is 16.2%.

Extreme sex differences are observed: severe disability prevalence for Ziarat District is

3.3% in men and 42% in women.

2.4 Most affected daily life areas In the MDS disability is estimated based on problems reported in 17 functioning domains: mobility, hand and arm use, self-care, seeing, hearing, pain, sleep and energy, breathing,

affect, interpersonal relationships, handling stress, communication, cognition, household tasks, community and citizenship participation, caring for others and work and schooling.

Each domain is assessed with several questions covering different areas and presented in graphs in the next pages for men (blue graphs) and women (red graphs).

Extreme problems with mobility are presented in Figure 4 and are one of the most affected

life areas both for men and women. Considering males, extreme problems are overwhelmingly reported by the men with severe disability. Considering females, although women with severe disability report considerable more frequently extreme problems, many

mobility areas are very problematic for women with moderate disability.

Extreme problems with self-care are overwhelmenly reported by persons with severe disability (Figure 5) but also considerably affect women with moderate disability.

Extreme problems with seeing and hearing are shown in Figure 6. More women than men report extreme problems, except for hearing in a noisy room. Pain, sleep and lack of energy

(tiredness) affect mostly men with severe disability (Figure 7) while in women, extreme problems with pain, sleep and lack of energy (tiredness) are observed across disability levels

(Figure 7).

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Considerably more persons with severe levels of disability experience extreme problems

with breathing: approximately 40% men and 36.5% of the women report extreme problems with coughing or wheezing (Figure 8).

Extreme problems with interpersonal relationships mostly affect women with moderate and severe disability (Figure 9) and the same pattern is observed for depressive and anxiety

feelings (Figure 10). Extreme problems with communication are relatively seldom and mostly reported by women

with severe disability (Figure 11) while extreme problems with cognition are observed across disability levels overwhelmingly in women (Figure 12).

Regarding household tasks, managing money and providing care, mostly men and women with severe disability face extreme problems (Figure 13). The same pattern is observed for

participation in society (Figure 14).

Men face extreme problems applying for and getting a job, independently of their level of disability, as do almost all women with moderate or severe disability (Figure 15).

The proportions of men facing extreme problems applying for and getting a job is very high and independent of the level of disability, ranging from 83% to 95% (Figure 15). Similarly,

almost all women with moderate or severe disability face extreme problems applying for and getting a job (Figure 15). Regarding getting things done at work, the same pattern is

observed for men and women: the higher the level of disability, the higher the proportion of persons facing problems (Figure 15).

Almost all persons with severe disability face extreme problems to get an education and to get things done at school (Figure 15).

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Mobility Figure 4: Percentages of men (blue) and women (red) rating mobility domains as very problematic or extremely problematic, by disability level.

0 0 0 0 0 0 2

9.8

0.8 0 0.8 03.9

0.8 1.6

20.6

8.1

16.2

2.7 4.5

27.9

5.4 4.5

48.2

70

60

80

60

90

80

60

80

0

10

20

30

40

50

60

70

80

90

100

Standing up Standing for 30minutes

Getting out ofyour home

Walking 100m Walking 1 km Engaging invigorousactivities

Getting whereyou want to go

Using public orprivate

transportation

No Mild Moderate Severe

0 0

25

0 0 0 0

12.5

21.5 22.8 22.829.1

40.5

12.7

32.9

47

73

84.1 84.181 81

74.679.4

84

0

10

20

30

40

50

60

70

80

90

100

Standing up Standing for 30minutes

Getting out ofyour home

Walking 100m Walking 1 km Engaging invigorousactivities

Getting whereyou want to go

Using public orprivate

transportation

Mild Moderate Severe

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Self-care

Figure 5: Percentages of men (blue) and women (red) rating self-care aspects as very problematic or extremely problematic, by disability level.

0 0 0 0 00 0 0 0 00 0 0.93.6 3.6

60

20

70

60

80

0

10

20

30

40

50

60

70

80

90

100

Being clean anddressed

Eating Toileting Cutting your toenails Looking after yourhealth


0 0 0 0 0

17.7

6.3

26.6

10.1

19

76.2

41.3

77.8

54

60.3

0

10

20

30

40

50

60

70

80

90

100

Being clean anddressed

Eating Toileting Cutting your toenails Looking after yourhealth


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Seeing and hearing Figure 6: Percentages of men (blue) and women (red) rating seeing and hearing as very problematic or extremely problematic, by disability level.

0 0 0 21.6 0 0 1.6

6.4 5.50

9

30

20

10

40

0

10

20

30

40

50

60

70

80

90

100

Seeing at a distance Seeing at arm's length Hearing in a quiet room Hearing in a noisy room


0 0 0 0

7.6 8.93.8

7.6

33.3 34.9

27 25.4

0

10

20

30

40

50

60

70

80

90

100

Seeing at a distance Seeing at arm's length Hearing in a quiet room Hearing in a noisy room


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Pain and daily life energy Figure 7: Percentages of men (blue) and women (red) rating pain, sleep and feeling tired as very problematic or extremely problematic, by disability level.

0 0

5.9

0 0.83.9

7.2 912.6

40

50

60

0

10

20

30

40

50

60

70

80

90

100

Pain Sleep Feeling tired


12.5 12.5

0

27.8 30.436.7

58.7

46

63.5

0

10

20

30

40

50

60

70

80

90

100

Pain Sleep Feeling tired


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Breathing

Figure 8: Percentages of men (blue) and women (red) rating breathing as very problematic or extremely problematic, by disability level.

0 00 02.7 1.8

10

40

0

10

20

30

40

50

60

70

80

90

100

Shortness of breath Coughing or wheezing


0 0

7.6 6.3

31.736.5

0

10

20

30

40

50

60

70

80

90

100

Shortness of breath Coughing or wheezing


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Interpersonal relationships Figure 9: Percentages of men (blue) and women (red) rating areas of interpersonal relationships as very problematic or extremely problematic, by disability level.

0 0 0 00.8 0.8 0.8 00.9

8.1 6.3 5.90

30

10 11.1

0

10

20

30

40

50

60

70

80

90

100

Getting along with peopleclose to you

Dealing with people you donot know

Initiating and maintainingfriendships

Intimate relationships


0 0 0 0

16.9 19.2 21.116.9

47.6

61.3

45.741.2

0

10

20

30

40

50

60

70

80

90

100

Getting along with peopleclose to you

Dealing with people you donot know

Initiating and maintainingfriendships

Intimate relationships


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Handling stress and emotional functions

Figure 10: Percentages of men (blue) and women (red) rating handling stress and emotional functions as very problematic or extremely problematic, by disability level.

7.82 0 01.6 1.6 0.8 1.6

11.7

2.7 1.87.2

30 30

50

60

0

10

20

30

40

50

60

70

80

90

100

Handling stress Coping with all the thingsyou have to do

Feeling sad, low ordepressed

Feeling worried or nervous


12.5

25

12.5

25

44.339.2

46.8

65.8

74.6

66.7

79.484.1

0

10

20

30

40

50

60

70

80

90

100

Handling stress Coping with all the thingsyou have to do

Feeling sad, low ordepressed

Feeling worried or nervous


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Communication Figure 11: Percentages of men (blue) and women (red) rating communication as very problematic or extremely problematic, by disability level.

0 00 00 0.9

10 10

0

10

20

30

40

50

60

70

80

90

100

Being understood Understanding others


0 0

7.63.8

25.428.6

0

10

20

30

40

50

60

70

80

90

100

Being understood Understanding others


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Cognition Figure 12: Percentages of men (blue) and women (red) rating cognition areas as very problematic or extremely problematic, by disability level.

0 0 01.6 0 0.8

17.1

2.75.4

30 30

20

0

10

20

30

40

50

60

70

80

90

100

Forgetfulness Remembering to do important things inday-to-day life

Finding solutions to day-to-dayproblems


37.5

25 25

39.2

55.7

48.1

76.2 77.8 77.8

0

10

20

30

40

50

60

70

80

90

100

Forgetfulness Remembering to do important things inday-to-day life

Finding solutions to day-to-dayproblems


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Handling household tasks

Figure 13: Percentages of men (blue) and women (red) rating household tasks, managing money and providing care areas as very problematic or extremely problematic, by disability level.

03.9 20.8

70.8

4.5

20.7

11.7

80

70

77.8

0

10

20

30

40

50

60

70

80

90

100

Household tasks Managing money you have Providing care to others


12.5

50

0

29.1

50.6

26.6

82.576.2

72.6

0

10

20

30

40

50

60

70

80

90

100

Household tasks Managing money you have Providing care to others


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Participation in society

Figure 14: Percentages of men (blue) and women (red) rating participation areas as very problematic or extremely problematic, by disability level.

0 04.2

00.8 0

11.2

05.5 5.4

31.4

4.5

50

6055.6

40

0

10

20

30

40

50

60

70

80

90

100

Doing things for relaxationor pleasure

Joining community activities Engaging in local or nationalpolitics or civil society

organizations

Voting in last election


0

12.5

50

2519

33.3 35.5

5052.4

77.4

69

80

0

10

20

30

40

50

60

70

80

90

100

Doing things for relaxationor pleasure

Joining community activities Engaging in local or nationalpolitics or civil society

organizations

Voting in last election


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Work and Education

Figure 15: Percentages of men (blue) and women (red) rating work and education areas as very problematic or extremely problematic, by disability level.

89.5

4

38.7

0

94.4

6.8

31.4

18.8

95

35.6

44

14.3

83.3

50

100

0

10

20

30

40

50

60

70

80

90

100

Applying for and getting a job Getting things done at work Getting an education Getting things done at school


40

14.3

25 25

100

50

42.946.7

9591.4

88.9

100

0

10

20

30

40

50

60

70

80

90

100

Applying for and getting a job Getting things done at work Getting an education Getting things done at school


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2.5 Health

2.5.1 Health conditions and impairments

Figure 16 shows the prevalence of self-reported health conditions or impairments by disability level, for men (blue) and women (red).

The top most common self-reported health conditions or impairments for men are: - Severe disability: depression, hypertension, diabetes, arthritis/arthrosis, back pain,

stroke, anxiety and skin diseases; - Moderate disability: depression, anxiety, vision loss, hypertension, kidney diseases; - Mild disability: vision loss, kidney diseases, anxiety, gastritis and hypertension.

The top most common self-reported health conditions or impairments for women are:

- Severe disability: depression, back pain, hypertension, kidney diseases, vision loss, hearing loss, arthritis/arthrosis, heart diseases, diabetes;

- Moderate disability: back pain, kidney diseases, hypertension, depression, vision loss,

arthritis/arthrosis, hearing loss; - Mild disability: back pain, hypertension, kidney diseases, arthritis/arthrosis, diabetes,

gastritis, migraine, asthma. Important to note are the very high prevalences of depression, back pain, hypertension and

kidney diseases across disability levels. All these prevalences are much higher in women than in men.

Figure 16: Self-reported health conditions or impairments, by disability level, for men (blue) and

women (red).

37.8

18

3.68.1

14.4

4.5

27

3.6

26.1

1.8

92.7 2.7 4.5 5.4

18

40

30 30

20 20 20 20 20

10 10 10 10 10 10 10 10 10

0

10

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100


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2.5.2 Capacity Capacity, or health state, is defined as the synthesis of all intrinsic physical and mental

capacities of a person, determined solely by his or her health conditions or impairments. A capacity score is estimated for every respondent based on difficulties in 17 functioning

domains (module 5000). Table 5 shows the proportions of the sample with mild, moderate and severe capacity

difficulties. Estimates are very similar to the disability estimates and show that the impact of the environment is not facilitating but hindering.

Table 5: Distribution of sample by capacity level


Capacity level N Percentage* N Percentage* N Percentage*

No difficulties 88 19.6 88 29.3 0 0 Mild difficulties 103 22.9 98 32.7 5 3.3 Moderate difficulties 188 41.8 104 34.7 84 56 Severe difficulties 71 15.8 10 3.3 61 40.7

Total 450 100% 300 100% 150 100% *Weighted percentage takes into account the sampling weight.

0

37.5

12.5 12.5 0 0 12.5 0 12.5 0 0 0

12.5 12.5

0 0 0 12.5

35.4

45.6

38 39.2

24.1

11.4

24.1

5.18.9

5.1 2.5 2.5 0

1.3

1.3 0 1.3

3.8

65.1

57.1

49.244.4

38.1

23.8

23.8

22.2 20.6

9.5 4.8 4.8

3.2

1.6 1.6

1.61.6

00

10

20

30

40

50

60

70

80

90

100


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2.6 Work

Approximately 28% of the men with severe disability are not working, compared to 0.8%

of the men with mild disability, and the higher the disability level, the lower the rates of men working for wages (Figure 17).

Approximately 70% of the women with severe disability and 40% of the women with moderate disability are not working, compared to 33.3% of the women with mild disability.

No women with severe disability is working for wages while approximately 7% work as unpaid family member (Figure 17). Figure 17: Work status of those who have ever worked, by disability level, for men (blue) and women (red).

0.8

41.2

21.8

35.3

0 0.80

26.720.8

47.5

0 0

28.6

14.3 14.3

28.6

14.3

00

10

20

30

40

50

60

70

80

90

100

Not working Working for wages Self-employed Working unpaidfamily member

Retired, healthcondition

Retired, age


33.3

50

0

16.7

0

43.237.8

0

18.9

0

71.4

07.1

14.3

7.1

0

10

20

30

40

50

60

70

80

90

100

Not working Working for wages Working for wages, onleave

Self-employed Working unpaid familymember


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2.7 Education

Figure 18 shows highest educational achievement. For men, the highest the level of disability, the higher the proportion of men with no education: from all men with no

education, approximately 43.3 % have moderate disability. For women, allmost all women with no education have either moderate or severe disability.

Figure 18: Highest level of education achieved, by disability, for men (blue) and women (red).

14.912.5

14.7

20.5

15.6

35.8

43.8

26.5

49.6

45.343.3 43.8

52.9

28.2

35.9

6

0

5.9

1.7 3.1

0

10

20

30

40

50

60

No education Elementary Vocational Secondary Higher


0 0 0 0 02.4 0 0

20

33.3

52.8

100

57.1

40 41.744.7

0

42.9 40

25

0

20

40

60

80

100

120

No education Elementary Vocational Secondary Higher


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2.8 Environmental factors

Environment is broadly defined in the MDS as the external factors that contribute to the lived experience of the individual, such as the availability of assistive devices, a supportive

family structure, the attitudes of peers, accessibility to health care or accessibility of transportation. Environmental factors disclosure needs, inequalities and barriers.

2.8.1 General environment

Very high proportions of men and women with any level of disability, but mostly the ones with severe disability, experience the physical environment as hindering or very hindering (Figure 19). Transportation, health facilities, workplace or school, and shops, banks and

post offices in the neighborhood are among the most hindering ones. Figure 19: Percentages of persons reporting that aspects of the general physical environment are hindering or very hindering, by disability level, for men (blue) and women (red).

0.0

11.8

0.0

13.77.8

2.0 2.07.8

11.9

29.7

7.9

43.0

0.8

15.6

8.6 8.6

34.4

27.5

49.5

20.7

63.1

36.0

4.5

11.7

24.3

0.9

85.790.0

50.0

88.9

30.0

90.0

60.0 60.0

40.0

20.0

0.0

10.0

20.0

30.0

40.0

50.0

60.0

70.0

80.0

90.0

100.0

workplace orschool

health facilities places tosocialize

shops, banks,post offices

places ofworship

transportation dwelling toilet of thedwelling

temperature,terrain and

climate

lightning, noiseand crows


50.0

12.5

0.0

16.7

0.0

12.5 12.5

0.0 0.0 0.0

68.2

38.0 39.7 39.6

8.3

46.2

8.9

31.636.7

7.6

90.5

78.7 81.4

88.9

37.3

82.5

50.0

79.4

69.8

50.8

0.0

10.0

20.0

30.0

40.0

50.0

60.0

70.0

80.0

90.0

100.0

workplace orschool

health facilities places tosocialize

shops, banks,post offices

places ofworship

transportation dwelling toilet of thedwelling

temperature,terrain and

climate

lightning, noiseand crows


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2.8.2 Personal assistance

A total of 26 men (70% with severe disability) and 57 women (58.7% with severe disability) report having personal assistance, mostly unpaid assistants (Table 6).

Of those, eight men (75% with severe disability) and 16 women (29.7% with severe disability) respond that they would need more assistance. Altogether 27 men and 7 seven

women report having no personal assistance but needing it. Table 6: Percentage of persons reporting personal assistance, by disability and sex.


N No Mild Moderate Severe N Mild Moderate Severe

Persons with personal assistance 26 11.8% 3.1% 8.1% 70% 57 0 25.3% 58.7%

Paid or charity organizations assistants 4 20% 50% 12.5% 14.3% 6 - 10% 10.8%

Unpaid assistants (family members, friends or volunteers)

17 60% 0% 87.5% 100% 55 - 100% 94.6%

Both paid and unpaid assistants 3 20% 0% 12.5% 14.3% 5 - 10% 8.1%

Persons with personal assistance who need more assistance

8 0 0% 22.2% 75% 16 - 23.8% 29.7%

Persons with no personal assistance who need assistance

27 4.3% 7.9% 13.7% 50% 7 0 3.4% 19.2%

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2.8.3 Attitudes of others

Extreme problems with attitudes of others are experienced by relatively high proportions of persons across disability levels (Figure 20 and Figure 21). However, persons with severe disability are frequently worst off: not being able of making big decisions in life is an extreme

problem for 60% of men with severe disability, while people not expecting much of oneself is a problem for 54% of women with severe disability. Women have more problems with

attitudes, across disability levels.

Figure 20: Percentage of persons endorsing mostly or completely to questions about attitudes of others, by disability level, for men (blue) and women (red).

52.9

3.9 3.9

21.625.5 23.5

28.9

13.3

3.9

30.527.3

9.411.7

38.7

3.6

17.1

42.3

10.8

30

10

40

30

60

20

0

10

20

30

40

50

60

70

80

90

100

Getting involved insociety

Being treatedunfairly

Considering oneselfa burden to society

People becomeimpatient with you

People don't expectmuch from you

Living with dignityis a problem


0 0 0 0

25

0

16.522.8

8.913.9

22.8

13.9

34.941.3

34.928.6

54

39.7

0

10

20

30

40

50

60

70

80

90

100

Getting involved insociety

Being treatedunfairly

Considering oneselfa burden to society

People becomeimpatient with you

People don't expectmuch from you

Living with dignityis a problem


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Figure 21: Percentage of persons endorsing no or not at all to questions about attitudes of others, by disability, for men (blue) and women (red).

11.8 11.817.6

13.7

27.9

13.3 14.1

5.5 3.98.1 9.9 9.9 8.1

3.6

20 20

60

10

20

0

10

20

30

40

50

60

70

80

90

100

Participate in familydecisions

Make own choicesabout your day-to-day

life

Make big decisions inyour life

Feel that others acceptyou

Feel that othersrespect you


75 75

50

0 0

51.9

32.9

53.2

21.513.9

47.6

20.625.4

17.511.1

0

10

20

30

40

50

60

70

80

90

100

Participate in familydecisions

Make own choicesabout your day-to-day

life

Make big decisions inyour life

Feel that others acceptyou

Feel that othersrespect you


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2.8.4 Access to information

Table 7 reports access to information by disability level. The largest proportions of men with no or mild disability have partly access to information while the largest proportions of men with moderate or severe disablity, have a little and not at all access, respectively. Most

women with mild or moderate disability have no access to information while most women with severe disability have partly access. Figure 22 shows the rates of persons with not at

all or little access to information they need or want by disability level and sex. Table 7: Percentage of persons with access to the information (Do you have access to the

information you need or want?) by disability level and sex.

Do you have

access to the

information you

need or want?

Men Women



Not at all 3.9% 4.7% 5.4% 30% 75% 46.2% 30.2%

A little 15.7% 21.9% 45.9% 20% 0 14.1% 3.2%

Partly 33.3% 50% 36.9% 10% 25% 23.1% 42.9%

To some extend 17.6% 14.1% 9% 20% 0 10.3% 17.5%

Completely 29.4% 9.4% 2.7% 20% 0 6.4% 6.3%

Total 100% 100% 100% 100% 100% 100% 100%

Figure 22: Rates of persons with not at all or little access to information they need or want, by

disability and sex.

19.626.6

51.3 50

75

60.3

33.4

0

10

20

30

40

50

60

70

80

90

100


Men Women

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2.8.5 Regular use of medication

Figure 23 shows regular medicine intake by disability level: as expected, the higher the disability level, the higher the proportion of persons taking medicines, for men and women. Figure 23: Regular medicine intake (percentages of persons) by disability level and sex.

2.8.6 Assistive products and modifications

Figure 24 shows unmet needs of assistive products and facilitators among those who do

not already use products, by disability level and sex.

Figure 24: Percentage of men (blue) and women (red), who do not use products, reporting unmet needs of assistive products and modifications, by disability level.

10.9

34.2

70

25

36.7

68.3

0

10

20

30

40

50

60

70

80


Male Female

1.64.9

0.8 0.8

12.8

70

16.5

23.6

12.117.3

1.8 2.7

33

4044.5

48.2

16.722.2

10 10

28.6

50

60

0

10

20

30

40

50

60

70

80

90

100

Mobility andself-care

Seeing Hearing Cognition Work Education Home Community


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Very few persons in the sample report the use of assistive technologies, and the most

commonly used ones are for mobility and self-care (11 men and 20 women use them, almost all with severe disability) and seing (10 men and 7 women use them, almost all with severe disability) (Table 8).

Table 8: Percentage of persons reporting use and additional need of assistive products and modifications by disability level and sex.

Men Women

N Mild Moderate Severe N Mild Moderate Severe

Mobility and self-care Use 11 10% 33.3% 80% 20 - 30.8% 80%

Use but need more 11 100% 100% 100% 18 - 50% 100%

Seeing Use 10 50% 26.3% 25% 7 - 15.4% 25%

Use but need more 6 50% 60% 100% 4 - 50% 60%

Education Use 1 10% 0% - 0 0% 0% 0%

Use but need more 1 100% - - 0 - - -

Modifications home Use 3 0% 0.9% 20% 1 0% 0% 1.6%

Use but need more 1 - 0% 50% 1 - - 100%

Modifications in the community

Use 4 0.8% 2.7% 0% 0 0% 0% 0%

Use but need more 5 100% 100% - 0 - - -

12.5

0 0 0 0 0 0 0

21.118.2

5.12.5

4.7

0

13.9

8.9

43.8

20.7

9.5

25.4

2.20

14.5

22.2

0

5

10

15

20

25

30

35

40

45

50

Mobility andself-care

Seeing Hearing Cognition Work Education Home Community


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2.9 Health care responsiveness

Figure 25 reports inpatient and outpatient health care utilization and access to care, by disability level and sex. Regarding men, 20% of men with severe disability report that they

didn’t receive the care they needed while 42.9% of the women who needed inpatient care report that they have not received it. Figure 25: Percentage of men (blue) and women (red) who used and didn’t get care by disability level.

Figure 26 shows how satisfied persons are with the health care they receive. A clear

difference between women with mild disability and women with moderate to severe disability is observed, with the latter being considerably less satisfied with all aspects. For

men, the pattern is also observed but less clear, what could be due to the fact that only 3.3% of men have severe disability.

0

100

11.110.9

0

92.2

3.412.2

0

87.8

2.5

60

0

100

20

0

20

40

60

80

100

120

Inpatient care used in thepast 3 years

Inpatient care needed but notreceived

Outpatient care used in thepast year

Outpatient care needed butnot received


0

100

0

10.3

0

74.1

0

28

42.9

70

2.9

0

20

40

60

80

100

120

Inpatient care used in thepast 3 years

Inpatient care needed but notreceived

Outpatient care used in thepast year

Outpatient care needed butnot received


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Figure 26: Percentages of men (blue) and women (red) endorsing aspects of the health system as good or very good, by disability.

66.7

77.8

88.9

77.8

88.9

77.8 77.8

44.4 44.442.2

84.4

76.681.2

67.2 67.2 67.2

25

37.5

17.8

57.8 55.6 54.448.9 48.9

52.2

11.1

25.6

40

80

30 30

40

70 70

30

20

0

10

20

30

40

50

60

70

80

90

100

Waitingtimes

Beingtreated with

respect

How clearhealth

providersexplainthings

Beinginvolved in

makingdecisions for

yourtreatment

Privacy Easeness ofchoosing ahealth care

provider

Cleanlinessof the health

facility

Satisfactionwith how thehealth careservices are

run inBalochistan

Satisfactionwith how

health carein Pakistan

involves youin deciding

whatservices to

provide andwhere


83.3

66.7

100

66.7 66.7

50

100 100 100

34.5

49.145.6

36.8

49.1 49.156.1

50.9

59.6

20.4

48 4840

4638

4436

44

0

10

20

30

40

50

60

70

80

90

100

Waiting times Being treatedwith respect

How clearhealth

providersexplain things

Being involvedin making

decisions foryour

treatment

Privacy Easeness ofchoosing ahealth care

provider

Cleanliness ofthe health

facility

Satisfactionwith how thehealth careservices are

run inBalochistan

Satisfactionwith how

health care inPakistan

involves you indeciding what

services toprovide and

where


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2.10 Well-Being

The MDS contains eight questions about quality of life, that are suitable for calculating a quality of life score ranging from 8.0 to 40.0, higher scores pointing out higher quality of

life. As shown in Figure 27, the higher the level of disability, the lower the quality of life. Figure 27: Mean quality of life score, by disability level and sex.

Disclaimer

The authors are staff members of the World Health Organization. The authors alone are

responsible for the views expressed in this publication and they do not necessarily represent the decisions or policies of the World Health Organization.

WHO/NMH/NVI/18.17

© World Health Organization 2018 Suggested citation. Model Disability Survey General Results: Ziarat District, Balochistan

Province, Pakistan. Geneva: World Health Organization; 2018 (WHO/NMH/NVI/18.17). Licence: CC BY-NC-SA 3.0 IGO

34.53

27.64

20.50

28.75

25.97

22.89

0.00

5.00

10.00

15.00

20.00

25.00

30.00

35.00

40.00


Male Female

Documents

MODEL DISABILITY SURVEY GENERAL RESULTS ZIARAT … · for persons with disability in Pakistan. The Taraqee Foundation is a non-governmental and non-profit national level organization