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Disability: Introduction & Concepts
PG Student: Dr. Santosh Kadle Grant Medical College,Mumbai
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Contents of seminar: Introduction Concept of disability Problem statement of disability- --Worldwide , India , Maharashtra Data sources for disability Various types of disability, causes of disability Certification of disability
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“Disabled people are not only the most deprived human beings in the developing world, they also the most neglected.”
----Amartya Sen
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Disability is the best example of the iceberg phenomenon of disease
[Source: S. Ganesh Kumar et al, Disability and Rehabilitation Services in India: Issues and Challenges, J Family Med Prim Care. 2012 Jan-Jun]
Self reported
cases Non reporting
Improper definition disability condition
Less knowledge& skills in health provider
Not accessed to services
Less frequency for Data collection
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Need of disability evaluation : Disability evaluation is useful for health care and policy decisions, in terms of: identifying needs matching treatments and intervention measuring outcomes and effectiveness setting priorities allocating resources
Source: http://www.who.int/topics/disabilities/en/
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Barriers faced by Persons with disabilities :
People with disabilities encounter a range of barriers when they attempt to access health care including the following: Prohibitive costs
Limited availability of services
Physical barriers
Inadequate skills and knowledge of health workers[Source: http://www.who.int/topics/disabilities/en/]
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Vulnerability of people with disabilities :• People with disabilities are particularly vulnerable to deficiencies in health care services.
• Depending on the group and setting, persons with disabilities may experience greater vulnerability to
1] secondary conditions, 2] co-morbid conditions, 3] age-related conditions, 4] engaging in health risk behaviors and 5] higher rates of premature death.
[Source: http://www.who.int/topics/disabilities/en/]
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According to the International Classification of Impairments, Disabilities, and Handicap [ICIDH]---
Impairment is concerned with physical aspects of health,
Disability has to do with the loss of functional capacity resulting from impaired organ,
Handicap is a measure of the social and cultural consequences of an impairment or disability.
Source: http://www.who.int/topics/disabilities/en/
Concept of Disability:
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Concept of Disability:
Disease is a pathological process and its manifestations which indicate a departure from the state of perfect health.
Impairment is the actual loss or damage of a part of body anatomy or an aberration of the physiological functions that occurs consequent to a disease.
Disability is defined as “the inability to carry out certain functions or activities which are otherwise expected for that age/sex, as a result of the impairment.”
Handicap is the final disadvantage in life which occurs consequent to an impairment or disability, which limits the fulfilment of the role a person is required to play in life.
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Concept of Disability:
According to the International Classification of functioning, Disability, and Health [ICF], 2001 Disabilities is an umbrella term, covering impairments, activity limitations, and participation restrictions. An impairment is a problem in body function or structure An activity limitation is a difficulty encountered by an individual in executing a task or action
A participation restriction is a problem experienced by an individual in involvement in life situations
[Source: http://www.who.int/topics/disabilities/en/]
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Concept of Disability:The Convention of Rights of Persons with Disabilities (UNCRPWD:United Nation, 2006 w.e.f. 8 May2008) Shift from a medical social model of disability
In Medical model— Individuals with certain physical , intellectual, psychological and mental conditions (impairment) are regarded as pathologic or abnormal
It is simply the abnormality conditions themselves that are the cause of all restrictions of activities
Disability lies in the individualsFeel pressured to work on ‘their’ restrictions adjusting to their environment through cures, treatment or rehabilitation.
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Concept of Disability:The Convention of Rights of Persons with Disabilities (UNCRPWD:United Nation, 2006 w.e.f. 8 May2008) Shift from a medical social model of disability
• In Social model- undue restrictions on behaviour of persons with impairment are seen to be imposed by: a) dominant social, political, and economics ideologies; b)cultural and religious perceptions regarding persons with disabilities; c) paternalism in social welfare systems; d) discriminations by society; e) the inaccessibility of the environment and information; and f) the lack of appropriate institutional and social arrangements
Disability does not lie in individuals, but in the interactions between individuals and society.
Persons with disabilities are right holders, and are entitled to advocate for the removal of barriers.
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Concept of Disability:• In India different definitions of disability conditions have been introduced for various purposes, essentially following the medical model and, as such, they have been based on various criteria of ascertaining abnormality or pathologic conditions of persons.
• In absence of a conceptual framework based on the social model in the Indian context, no standardisation for evaluating disability across methods has been achieved.
• In common parlance, different terms such as disabled, handicapped, crippled, physically challenged, are used inter-changeably, indicating noticeably the emphasis on pathologic conditions .
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Concept of Disability:According to The Persons with Disabilities (Equal Opportunities, Protection of Rights and Full Participation) Act, 1995 "Person with disability" means a person suffering from not less than 40 % of any disability as certified by a medical authority (any hospital or institution, specified for the purposes of this Act by notification by the appropriate Government).
As per the act "Disability" means - (i) Blindness; (ii) Low vision; (iii) Leprosy-cured; (iv) Hearing impairment; (v) Loco motor disability; (vi) Mental retardation; (vii) Mental illness
[Source: http://www.socialjistice.nic.in]
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Problem statement :About 15% of the world's population lives with disability
2-4% experience significant difficulties in functioning.
The global disability prevalence is higher than previous WHO estimates, which suggested a figure of around 10%.
This global estimate for disability is on the rise due to -population ageing -rapid spread of chronic diseases, -improvements in the methods to measure disability. [Source: http://www.who.int/disabilities/facts]
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Three objectives: To remove barriers and improve access to health services
To strengthen and extend rehabilitation services.
To strengthen data collection and support research on disability and related services.
Better health for all people with disability
[Source: http://www.who.int/disabilities/actionplan/en/]
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Problem statement of disability in India :• Census 2001 are 2.19 crore and are 2.13 percent of the total population of the Country. These include persons with visual, hearing, speech, locomotor and mental disabilities.
• According to the 58th round of National Sample Survey(NSS)of 2002, there were 208 lakh persons with disabilities in 2002 .
• As per Census 2011 are 2.68 crore and are 2.21 percent of the total population of the Country. These include persons with visual, hearing, speech, locomotor, mental retardation, mental illness , any other and multiple disability .
• The Census and the NSS have different sampling design. In both sources, disability was self-reported.
[Source: http://www.censusindia.gov.in/disabilitydata]
Sr.No.
Year Data source Disabled population
%
1 2001 Census 2001 2.19 crore 2.13 %
2 2002 NSSO 2002 2.08 crore 2.01 %
3 2011 Census 2011 2.68 crore 2.21 %
The Census and the NSS have different sampling design. In both sources, disability was self-reported.
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NUMBER OF DISABLED POPULATION AND TYPE OF DISABILITY
Population Percentage (%)
Total population 1,028,610,328 100.0Total disabled population 21,906,769 2.13
Disability rate ( per lakh population)
2,130 --
Type of Disability(a) In seeing 10,634,881 1.0(b) In speech 1,640,868 0.2(c) In hearing 1,261,722 0.1(d) In movement 6,105,477 0.6(e) Mental 2,263,821 0.2 [Source: http://www.censusindia.gov.in/2001census/C-series/c-20.html ]
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NUMBER OF DISABLED POPULATION AND TYPE OF DISABILITY ….. Population Percentage (%)Total population 1,210,569,573Total disabled population
26,810,557 2.21
Disability rate ( per lakh population)
2,210
Types of disability…………………………………………y
(a) In seeing 5,032,463(b) In speech 5,071,007(c) In hearing 1,998,535(d) In movement 5,436,604(e) Mental Retardation 1,505,624(f) Mental illness 722,826(g) Any other 4,927,011(h) Multiple disability 2,116,487
[Source: http://www.censusindia.gov.in/2001census/C-series/c-20.html]
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56%
44%Males Females
[Source: http://www.censusindia.gov.in/2011census/C-series]
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Total Rural Urban1.75
1.80
1.85
1.90
1.95
2.00
2.05
2.10
2.15
2.20
2.25
2.13
2.21
1.93
2.212.24
2.17
Proportion of Disabled Population by ResidenceIndia : 2001-11
2001 2011
Perc
enta
ge
[Source: C-Series, Table C-20, Census of India 2001 and 2011]
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Disabled Population by Type of DisabilityIndia : 2011
Type of Disability Persons Males FemalesTotal 26,810,557 14,986,202 11,824,355
1] In Seeing 5,032,463 2,638,516 2,393,947
2] In Hearing 5,071,007 2,677,544 2,393,463
3] In Speech 1,998,535 1,122,896 875,639
4] In Movement 5,436,604 3,370,374 2,066,230
5] Mental Retardation 1,505,624 870,708 634,916
6] Mental Illness 722,826 415,732 307,094
7] Any Other 4,927,011 2,727,828 2,199,183
8] Multiple Disability 2,116,487 1,162,604 953,883
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Disabled Population by Type of Disability (%) India: 2011
[Source: http://www.censusindia.gov.in/2011census/C-series]
In Seeing18.8 %
In Hearing18.9 %
In Speech7.5 %
In Movement20.3 %
Mental Re-tardation
5.6 %
Mental Illness2.7 %
Any Other18.4 %
Multiple Disability
7.9 %
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Proportion of Disabled Population by Type of Disability
India : 2011
Type of Disability Persons Males Females1.In Seeing 18.8 17.6 20.2
2.In Hearing 18.9 17.9 20.2
3.In Speech 7.5 7.5 7.4
4.In Movement 20.3 22.5 17.5
5.Mental Retardation 5.6 5.8 5.4
6.Mental Illness 2.7 2.8 2.6
7.Any Other 18.4 18.2 18.6
8.Multiple Disability 7.9 7.8 8.1
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( % )
In Seeing
In Hearing
In Speech
In Move
ment
Mental Retardation
Mental Illness
Any Other
Multiple Disabilit
y0.0
5.0
10.0
15.0
20.0
25.0
18.8 18.2
7.0
21.7
5.5
2.7
17.7
8.5
18.720.5
8.5
17.1
5.9
2.8
20.0
6.5
Disability by Type and Residence, India, 2011
Rural Urban
Axis Title
Axis Title
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Problem statement of disability in Maharashtra :.
[Source: http://www.censusindia.gov.in/disabilitydata]
Sr.No.
Year Data source Disabled population
%
1 2001 Census 2001 1.6 million 1.97 %2 2002 NSSO 2002 12.37
lakhs 2.89 %
3 2011 Census 2011 29.63 lakhs
2.69 %
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Disabled Population by Type of DisabilityMaharashtra : 2011
Type of Disability Persons Males FemalesTotal 2963392 1692285 12711071] In Seeing 574052 311835 2622172] In Hearing 473271 264956 2083153] In Speech 473610 260792 2128184] In Movement 548418 357348 1910705] Mental Retardation 160209 90408 698016] Mental Illness 58753 32907 258467] Any Other 510736 279048 2316888] Multiple Disability 164343 94991 69352
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Proportion of Disabled Population by Type of DisabilityMaharashtra : 2011
Type of Disability Persons Males Females1.In Seeing 19.4 18.4 20.62.In Hearing 16.0 15.7 16.43.In Speech 16.0 15.4 16.74.In Movement 18.5 21.1 15.05.Mental Retardation 5.4 5.3 5.56.Mental Illness 2.0 1.9 2.07.Any Other 17.2 16.5 18.28.Multiple Disability 5.5 5.6 5.5
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Disabled Population by Type of DisabilityMumbai : 2011
Type of Disability Persons Males FemalesTotal 242343 138652 1036911] In Seeing 61269 34558 26711
2] In Hearing 57586 32253 25333
3] In Speech 34992 19808 15184
4] In Movement 23117 14731 8386
5] Mental Retardation 10460 6200 4260
6] Mental Illness 3741 2102 1639
7] Any Other 42271 23796 18475
8] Multiple Disability 8907 5204 3703
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Proportion of Disabled Population by Type of Disability
Mumbai : 2011
Type of Disability Persons Males Females1.In Seeing 25.3 24.9 25.82.In Hearing 23.8 23.3 24.43.In Speech 14.4 14.3 14.64.In Movement 9.5 10.6 8.15.Mental Retardation 4.3 4.5 4.16.Mental Illness 1.5 1.5 1.67.Any Other 17.4 17.2 17.88.Multiple Disability 3.7 3.8 3.6
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Types of disability:
1] Visual disability 2] Hearing disability 3] Speech disability 4] Locomotor disability 5] Mental disability 6] Mental illness 7] Multiple disability
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1] Visual disability:Definition – as per PWD act1995, "Blindness" refers to a condition where a person suffers from any of the following conditions, Total absence of sight. Visual acuity not exceeding 6/60 or 20/200 (Snellen) in the better eye with correcting lenses;
Limitation of the field of vision subtending an angle of 20 degree or worse;
"Person with low vision" means a person with impairment of visual functioning even after treatment or standard refractive correction but who uses or is potentially capable of using vision for the planning or execution of a task with appropriate assistive device;
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1] Visual disability:• As per Census 2001. Seeing disability: A person who cannot see at all (has no perception of light) or has blurred vision even with the help of spectacles. A person with proper vision only in one eye was also treated as visually disabled. A person may have blurred vision and had no occasion to test whether her/his eyesight would improve by using spectacles - such persons were treated as visually disabled.
• As per NSSO 2002-For the survey, visually disabled included (a) those who did not have any light perception - both eyes taken together and (b) those who had light perception but could not correctly count fingers of hand (with spectacles/ contact lenses if he/ she used spectacles/ contact lenses) from a distance of 3 metres (or 10 feet) in good day light with both eyes open. Night blindness was not considered as visual
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Visual disability:• Common causes of blindness and visual impairments: -cataract (81%) - refractive errors (7%) -glaucoma (2%) - corneal ulcer , opacity (3%) -trachoma (0.2%) -other (6.76%) [ xerophthalmia , conjunctivitis ,retinal detachment , astigmatism, nystagmus ,optic atrophy , retinitis pigmentosa ]
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2] Hearing disability:
As per PWD act 1995, "Hearing impairment" means loss of sixty decibels or more in the better ear in the conversational range of' frequencies.As per Census 2001, “A person who cannot hear at all (deaf), or can hear only loud sounds was considered to have hearing disability. If a person cannot hear through one ear but her/his other ear is functioning normally , she/ he was still considered to have hearing disability.A person who is able to hear using hearing aid, was not considered as disabled under this category.As per Census 2011, Persons using hearing aid have been treated as disabled .
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Hearing disability:Causes- old age , occupational, post infections- csom , injury , congenital
Severity of hearing disability-profound- could not hear at all or could only hear loud soundssevere - could hear only shouted words or could hear only if the speaker was sitting in the front.
moderate - disability was neither profound nor severe. usually ask to repeat the words spoken by the speaker or would like to see the face of the speaker while he/she spoke or would feel difficulty in conducting conversations.
mild - has difficulty in hearing but it does not interfere in day today conversation
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3] Speech disability:As per Census 2001,“ A person who is dumb or whose speech is not understood by a listener of normal comprehension and hearing, was considered to have speech disability.” Persons who stammer but whose speech is comprehensible were not classified as disabled by speech.As per Census 2011 , “persons who speak in single words and are not able to speak in sentences” was specifically mentioned to be treated as speech disabled.
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4] Locomotor disability:Loco motor disability" means disability of the bones, joints muscles leading to substantial restriction of the movement of the limbs or any form of cerebral palsy.• As per Census 2001, Movement Disability: A person, who lacks limbs or is unable to use the limbs normally, was considered to have movement disability. -If any part of the body is deformed -A person, who cannot move herself/himself without the aid of another person or without the aid of stick, - A person who is unable to move or lift or pick up any small article placed near her/him .- A person who may not be able to move normally because of problems of joints like arthritis and has to invariably limp while moving.
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4] Locomotor disability: Specific mention of the following was made in the definition for Census 2011:1.Paralytic persons2.Those who crawl3.Those who are able to walk with the help of aid4.Have acute and permanent problems of joints/muscles5.Have stiffness or tightness in movement or have loose, involuntary
movements or tremors of the body or have fragile bones6.Have difficulty balancing and coordinating body movement7.Have loss of sensation in body due to paralysis, Leprosy etc.8.Have deformity of body like hunch back or are dwarf.
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5] & 6] Mental Disability
• As per Census 2001, Mental disability: A person who lacks comprehension appropriate to her/his age was categorised as mentally disabled. Mentally retarded and insane persons were treated as mentally disabled. • As per NSSO 2002-• Mental disability: Persons who had difficulty in understanding routine instructions, who could not carry out their activities like others of similar age or exhibited behaviours like talking to self, laughing/ crying, staring, violence, fear and suspicion without reason were considered as mentally disabled for the purpose of survey.
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5]Mental Retardation
• New category introduced at Census 2011. • Mental retardation" means a condition of arrested or incomplete development of mind of a person which is specially characterized by sub normality of intelligence.
• % of disability in MR [As per GOI,13 June 2001]• ]• ]
Sr.No
Type of mental retardation % of disability
1 Mild Mental Retardation 50 %2 Moderate Mental Retardation 75%3 Severe Mental Retardation 90%4 Profound Mental Retardation 100%
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6] Mental illness
New category introduced at Census 2011. Mental Illness was covered under the category of
Mental disability at Census 2001
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7] Any other disability:New category introduced at Census 2011 to ensure complete coverage.
This option enabled respondents to report those disabilities which are not listed in the question.
In such cases, where informant was not sure about the type of disability this option of reporting disability as ‘Any Other’ was available to her/him.
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8] Multiple disability:New category introduced at Census 2011. The question has been designed to record as many as three types of disabilities from which the individual was reported to be suffering.
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Data sources for disability:
Census Data-1872-1931,1981,2001,2011 NSSO Rounds-1981,1991,2002 Hospital Data Special Survey by NGO, Govt. Literature Research studies
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Historical Perspective of disability in Census :
In Census 2011, information on eight types of disability has been collected
In Census 2001, information on five types of disability was collected
The question was dropped in Census 1991
In Census 1981, information on three types of disability was collected
The question on disability was not canvassed in the Censuses from 1941 to 1971
The question on disability was canvassed in all the Censuses since 1872 to 1931
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National sample survey [NSSO]:Sr.No
National sample survey
Round of NSS
Time of survey Disability Included
Prior to 1981, NSS surveys were restricted to only the physically handicapped persons.1 First 36 th
roundJuly-Dec 1981
visual , communication (i.e. hearing and/ or speech) and loco-motor.
2 Second
47 th round
July-Dec 1991
visual , communication (i.e. hearing and/ or speech) and loco-motor.
3 Third 58 th round
July-Dec 2002
visual , hearing, speech , loco-motor & mental disability
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Present Dataset –Census 2011
The present set of results pertains to data collected in the Census 2011 on disability.
Information on disability of individuals was collected during the Population Enumeration phase of Census 2011 through ‘Household Schedule’ . Similar information was collected during 2001 census also.
Information for individuals residing in ‘Normal’, ‘Institutional’ and ‘Houseless’ households was collected.
The table C-20- ‘Disabled by age-group and type of disability’ has been generated on the basis of processing 100% Census Schedules.
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Features of Disability Question, 2011 Has a filter question to ascertain disability status.
Attempts to collect information on eight types of disabilities as against five in Census 2001.
Designed to cover most of the disabilities listed in the “Persons with Disabilities Act, 1995” and “The National Trust Act, 1999”.
The placement of the question on disability in the Census Schedule was changed. The question was brought forward at Q-9 at Census 2011. This was the question No. 15 at the Census 2001.
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Questions Canvassed in Census 2011
Codes
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Disability certificate guidelines: As per the persons with Disabilities Act, 1995, seven disabilities are applicable : (1) Blindness (2) Low vision (3) Leprosy-cured (4) Hearing impairment (5) Loco motor disability (6) Mental retardation (7) Mental illness
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Disability certificate guidelines:• A Medical Board of three doctors including one specialist from Medical Department examines the disabled person and issues the disability certificate in case of 40% or more percentage disability.
• The Medical Board after due examination give a permanent disability certificate in cases of such permanent disabilities where there are no chances of variation in the degree of disability.
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Challenges In Issuing Certificate: Duplications Identification of real persons with Disabilities Difficult for the authorities to reach the beneficiaries
Lack of awareness among the Medical professionals
Element of subjectivity Pressure from politically motivated groups
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In Maharashtra:• In SADM- (Software for Assessment of Disability- Maharashtra) online issuance of disability certificates,-mainly five (i) Visual impairment (ii) Hearing impairment (iii) Physical/Locomotor (iv) Mental retardation (v) Mental illness
• In Maharashtra, the issuance of Disability certificates is the responsibility of PHD (Public Health Department) and DMER (Department of Medical Education and Research).
• For this the three departments-PHD,DMER& SJSAD(Social Justice and Special Assistance Department) came together and helped the IT department in developing this software.
[Source: http://sadm.maharashtra.gov.in/sadm ]
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Benefits of SADMElement of subjectivity and discretion is minimal Unique ID Duplication checkCentralized database of all Disabled Centralized database of Doctors/Specialists in the state
Linkage to Aadhaar (UID Number of the application) Transparency and Tracking Real Time Reports Govt. & NGO’s can avail the data Public Domain
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Governments positive initiative:Special department –Department of empowerment of persons with disability from 2012.
Accessible India Campaign- “Sugamya Bharat Abhiyan” 2015
“To make India-Differently Abled-Friendly”
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Sugamya Bharat Abhiyan• The Minister of Social Justice and Empowerment on 24 sept 2015 launched Accessible India campaign
• To make public buildings, public transportation, signage accessible to Persons with Disabilities.
• The Centre will identify more than 50 buildings in 50 major cities
• Four cities from Maharashtra including Mumbai, Pune, Nagpur, and Nashik will figure in the list of cities for the Accessible India campaign
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International year for disability: 1981 International day for disability: 3, December
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Way forward :Scope to improve in defining the concepts of disabilityPositive signs from government with good initiativesScope in research studies on disability and use for policy making.
Change should be “Benefits Approach” to “Right's Approach”
Universal accessibility to health care services. Disability friendly environment creation like transport and other public facilities.
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“The problem is not how to wipe out the differences but how to unite with the differences intact”.
– Rabindranath Tagore
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References:1] IAS Topper Ira Singhal: Success story revealed.indiatoday.in.New Delhi. July 6,2015 available on http://indiatoday.intoday.in/education/story/ias-topper-ira-singhal/1/449482.html2] Blind IAS candidate Ajit fulfills his Dream. Careers 360,Educational Hub.09 May2014,available on http://www.motivation.careers360.com/node/149293] S. Ganesh Kumar et al, Disability and Rehabilitation Services in India: Issues and Challenges, J Family Med Prim Care. 2012 Jan-Jun; 1(1): 69–73. 4] World Report on Disability. Geneva: WHO; 2011. World Health Organization downloaded from http://www.who.int/disabilities/world_report /2011/en/ 5] Census of India 2011. Data on disability. Office of the Registrar General and Census Commissioner, India. Available from : http://www.censusindia.n6] World Health Organization. International Classification of Functioning , Disability and Health 2001. Available from http://www.who.int/classification/icf/en
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References:7]Persons with disability act,1995 from https://sadm.Maharashtra.gov.in/sadm/GRs/PWD%20 Act.pdf downloaded on 10 sept20158] Disability status in India,58 th NSSO report, downloaded from http://www.socialjustice.nic.in/aboutdivision3.php on 10 sept2015
9] The Disabled: Health and Human Rights downloaded from http://www,cehat.org/humanrights/lenichchoudhari.pdf on 10 sept 201510]Information on Accessible India Campaign, Press information bureau ,Govt. of India, available on https://pibindia.wordpress.com/2015/08/17/accessible-india-campaign-sugamya-bharat-abhiyaan-to-make-india-disabled-friendly/11] Public buildings in Mumbai, key Indian cities to be made disabled friendly, article in The Hindu date 26 sept 2015 available on http://http://www.thehindu.com/news/cities/mumbai/public-buildings-in-mumbai-key-indian-cities-to-be-made-disabled-friendly/article7692547.ece
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YOU
