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About the Author Bupinder Zutshi, Ph. D., Center for the Study of Regional Development, Jawaharlal Nehru University, New Delhi, India. Email: bzutshi@vsnl.com, Phone: 011-31067803 Currently teaching at Centre for the Study of Regional Development, Jawaharlal. Nehru University, New Delhi, has more than 25 years of teaching experience at post-graduate and research level. Has taught at Utkal University, Kashmir University and Jawaharlal Nehru University. His fields of interest include population studies, child labour, child education, gender studies and regional development. Has published four books and several research articles in journals of repute. Has completed several research and field action oriented projects on child education, child labour, Non-formal education, gender studies and disabled population. These projects were sponsored by the UNESCO (New Delhi), UNESCO:IBE (Geneva), United Nations High Commissioner for Human Rights (Geneva), International Labour Organization (New Delhi), the National Human Rights Commission of India, the Policy Science Center, Inc., funded by the Learning and Research Program on Culture and Poverty of the World Bank, the Ford Foundation and the Indian Council of Social Science Research. Research P.K.Prasad Aruna Rai Associate: Research P.P. A.K. Kapoor Assistants: Tripathi, Computer Satyendra Anish Kapoor Assistance: Kumar Cartographic Puspahas Panigrahi Assistance: Abbreviations and Acronyms Abbreviations ADA ADDA ADDI ADHD ADIP AJRRC AK ALIMCO AP ATC B.Ed. B.Sc. BDDA CACU CAN CCPD CF CP CRCs Name American Disability Act Australian Disability Discrimination Act Action for Ability Development and Inclusion Attention Deficit and Hyperactivity Disorder Assistance to Disabled Persons for Purchase/ fitting of Aids and Appliances Amar Jyoti Research and Rehabilitation Center Asha Kiran Artificial Limb Manufacturing Corporation of India Akshay Pratishthan Adult Training Center Bachelor of Education Bachelor of Science British Disability Discrimination Act Central Administrative and Coordination Unit Concerned Action and Now Chief Commissioner for Persons with Disability Cystic Fibrosis Cerebral Palsy Composite Regional Centers CRCs CSE DDA DDRCs DGET DIN DRCs FOD HI HM IAY IB ICDS ICIDH IEDC IJDR ILO IPH ISIC ITIs LC MD MESH MI MOU MR NAB NCPEDP NCT NDMC NGO NHFDC NICDR NIDRR NIHH NIMH NIOH NIRTAR NIVH NSSO NTMRCP ODA OH OPD PWD RC RCBR RCI RRCs RRTCs SGSY SSNI Composite Regional Centers for Persons with Disability Center for Special Education Delhi Development Authority Districts Rehabilitation Disability Centres Directorate General of Employment &Training Disability India Network District Rehabilitation Centers Family of Disabled Hearing Impairment Home Management Indira Awaas Yojana Institute for the Blind Integrated Child Development Schemes International Classification of Impairments, Disabilities and Handicaps Integrated Education for the Disabled Children Indian Journal on Disability and Rehabilitation International Labour Organization The Institute for the Physically Handicapped Indian Spinal Injury Center Industrial Training Institutes Locomotor Impairment Medical Disabilities Maximizing Employment to Serve the Handicapped Mental Illness Memorandum of Understanding Mental Retardation National Association for the Blind The National Center for Promotion of Employment for Disabled Persons National Capital Territory New Delhi Municipal Corporation Non-Governmental Organization National Handicapped Finance and Development Corporation National Information Center on Disability and Rehabilitation National Institute of Disability and Rehabilitation Research National Institute for the Hearing Handicapped National Institute for the Mentally Handicapped National Institute for the Orthopaedically Handicapped National Institute of Rehabilitation Training & Research National Institute for the Visually Handicapped National Sample Survey Organization Assistance to Organizations for Persons with Cerebral Palsy and Mental Retardation Oversea Development Administration of United Kingdom Orthopeadically Handicapped Out Patient Department Persons with Disability Act 1995 India Equal Opportunity, Protection of Rights and Full Participation Resource Center Rural Community Based Service Rehabilitation Council of India Regional Rehabilitation Centers Regional Rehabilitation Training Centers Swarnjayanti Gram Swarozgar Yojana Spastics Society of Northern India TA TDMM UCBR UNDP UNESCO UNICEF VI VO VRCs WHO Tamana Association Science and Technology Development Projects in Mission Mode Urban Community Based Rehabilitation United Nations Development Programme United Nations Educational, Scientific and Cultural Organization United Nations International Children's Fund Visual Impairment Voluntary Organizations Vocational Rehabilitation Centers World Health Organization Acknowledgements I wish to put on record my gratitude to the Ford Foundation of India, New Delhi for having given me an opportunity to conduct the research study on the DISABILITY STATUS IN INDIA- A CASE STUDY OF DELHI METROPLOLITAN REGION My deeep appreciation and sincere acknowledgements go to Professor K. Warikoo and Dr. Sharad. K. Soni from Himalayan Research and Cultural Foundation, New Delhi and Dr. Deepa Nag Haksar, Secretary, DIVAIndia for providing all possible academic and administrative support and guidance in solving many financial and administrative problems from time to time. I am deeply indebted to the Project Coordinators of Project - Applied Ethics Institute of India, Governing Body members of the Himalayan Research and Cultural Foundation and DIVA- India for making the necessary arrangements to carry out the research work. All members have been extremely cooperative, accommodative, and non-interfering throughout the period of study. I am also grateful to members of Initiative for Social Change and Action, particularly to Professor C.J. Daswani, Professor Z. M. Shahid Siddiqui, Professor Tillottama Daswani, and Ms. Mariam Karim for their stimulating academic thoughts on disability sector in India. Dr. Mondira Dutta deserves a special thanks for being supportive at all stages including the organizing of the seminar and particularly drafting the proceedings of the seminar on Services for differently Abled Persons in India. I am grateful to Justice Rajinder Sachhar (Ex-Chief Justice of Delhi High Court), Mr. Javed Abidi, Director, National Centre for Promotion of Employment for Disabled People (NCPEDP), staff and officials from Institute for Physically Handicapped and Vocational Rehabilitation Centre for Disabilities in Delhi and representatives from Civil Society Organizations like National Association for the Blind (New Delhi), Amar Jyoti, Hemophilia Federation, Institute of Public Opinion, Institute of Research and Action Planning, Awaaz Special School, DLDAV, Association of Kashmiri Samiti, Indian Social Institute, Manzil Welfare Society, SAI Pragya Institute, ADDI (Spastic Society of India), Delhi Brotherhood Society, Sadhu Vaswani School, Family of Disabled, SPANDAN, Blue Bell School, Delhi Association of Deaf, TWMR Special Institute, DOON Research and Rehabilitation Centre for Handicapped, Child Guidance Centre, ADHAAR, VIDYA, Spastic Society (Delhi) and Mass media, All India Radio and other print media for attending one day seminar organised by the AEII at India International Centre, New Delhi on 21st June 2003. . I am grateful for the unrestrained support and cooperation showered upon my research team by the office staff of Rehabilitation Council of India, New Delhi, Ministry of Social Justice and Empowerment, Government of India, Department of Social Welfare, Government of NCT of Delhi, Office of the Chief Commissioner for persons with disability and NGOs associated with the services for disability sector in Delhi. I am thankful to the differently abled and challenged persons seeking services and support from different NGOs for enriching our knowledge about disability challenges and prospects during the course of our interviews with them. Their support and cooperation was valuable to prepare the report. I am thankful to my entire team who has tried hard to help me complete this study. Special mention needs to be made about Mr. P.K.Prasad, Aruna Rai, Sumit Arora, Ashok Kapoor, Praveen Kumar Choudhari, Anish Kapoor, Puspahas, P.P. Tripathi and other office staff of AEII, who spent months together in the field supervising the survey work. Last but not the least my sincere thanks go to my children Aneesh and Ipshita for constant help, support and inspiration and helping me in designing the lay out of the presentation of this report. Dr. Bupinder Zutshi List of Contents i. ii iii. iv. v. vi vii vii Part-I • Section -1 • Section -2 • Section -3 • Section-4 PART-II • • • • • Section-1 Section -2 Section -3 Section-4 Section-5 • Section-6 • Section-7 PART-III • Section-1 • Section-2 • Section-3 PART-IV • Section-1 • Section-2 • Section-3 • Section-4 PART-V PART-VI Title Disclaimer About the Author and the Team Members Abbreviations Acknowledgements Contents List of Tables List of Diagrams List of Maps Preface Executive Summary Disability- Definition, Types and International and National Initiatives Definitional Aspects Disability Types International Initiatives National Initiatives Disabled Person in India- Magnitude, Composition and Characteristics All Disabled -Magnitude and Characteristics Disabled Persons Types Locomotor Impaired Persons- Composition and Characteristics Hearing Impaired Persons- Composition and Characteristics Visually Impaired Persons- Composition and Characteristics Speech Impaired Persons- Composition and Characteristics Mentally Impaired Persons- Composition and Characteristics Services and Facilities Disability Sector- Welfare Institutes Concession and Facilities Implementation Status of PWD-Act 1995 Delhi- Disability Magnitude and Services Delhi Metropolitan Region- Magnitude Services for Disabled Persons Voluntary Sector Support NGOs- Good Practice Initiatives Conclusions & Recommendations References and Bibliography Annexes 1. Delhi NGOs- Working for Disabled Persons 2. Delhi NGOs Selected for Survey 3. Questionnaire for NGOs 4. Questionnaire for Disabled Person 5. Surveyed Disabled Persons 6. Seminar Report List of Tables S. No. Table No. Table Name 1 II.1.1 Disabled Population in India- Magnitude 2 II.1.2 Disabled Population in India Gender Distribution 3 II.1.3 Disabled Population in India Rural/ Urban Distribution 4 II.1.4 Disabled Population in India- Prevalence Rate 5 II.1.5 Disabled Population in India - Prevalence Rate- Age Groups 6 II.1.6 State wise Prevalence Rate Males, Rural/ Urban 1991-2002 7 II.1.7 State wise Prevalence Rate Females, Rural/ Urban 1991-2002 8 II.1.8 Disabled Population in India- Incidence Rate 9 II.1.9 Disabled Population in India - Incidence Rate- Age Groups 10 II.1.10 State wise Incidence Rate Males, Rural/ Urban 1991-2002 11 II.1.11 State wise Incidence Rate Females, Rural/ Urban 1991-2002 12 II.1.12 Number of Disabled Person in Disabled Households 13 II.1.13 Onset of Disability Since Birth 14 II.1.14 Severity of Disability 15 II.1.15 Disabled Population in India Age Distribution 16 II.1.16 Disabled Population in India Social Composition 17 II.1.17 Disabled Population in India Marital Status 18 II.1.18 Disabled Population in India Current Living Arrangements 19 II.1.19 Disabled Population in India Education Status 20 II.1.20 Disabled Population in India Usual Work Activity Status 21 II.1.21 Disabled Population in India Work Activity Status 22 II.1.22 Disabled Population in India Work Status Before and After Disability 23 II.2.1 Disabled Population in India Types and Magnitude 24 II.3.1 Locomotor Impaired Persons - Magnitude 25 II.3.2 Locomotor Impaired Persons Prevalence Rate 26 II.3.3 Locomotor Impaired Persons State wise Prevalence Rate, Males 27 II.3.4 Locomotor Impaired Persons State wise Prevalence Rate, Females 28 II.3.5 Locomotor Impaired Persons Prevalence Rate- Age Groups 29 II.3.6 Locomotor Impaired Persons Incidence Rate 30 II.3.7 Locomotor Impaired Persons Incidence Rate- Age Groups 31 II.3.8 Locomotor Impaired Persons- Age at Onset of Impairment 32 II.3.9 Locomotor Impaired Persons- Degree of Impairment 33 II.3.10 Locomotor Impaired Persons- Causes of Impairment 34 II.3.11 Locomotor Impaired Persons- Education Status 35 II.3.12 Locomotor Impaired Persons- Work Activity Status 36 II.3.13 Locomotor Impaired Persons- Work Activity Status After Disability 37 II.4.1 Hearing Impaired Magnitude 38 II.4.2 Hearing Impaired Prevalence Rate 39 II.4.3 Hearing Impaired State wise Prevalence Rate- Males 40 II.4.4 Hearing Impaired State wise Prevalence Rate- Females 41 II.4.5 Hearing Impaired Prevalence Rate Age Groups 42 II.4.6 Hearing Impaired Incidence Rate Page No. 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 66 67 68 69 69 70 71 72 73 74 75 76 77 78 79 80 81 82 83 84 85 86 87 88 89 90 91 92 II.4.7 II.4.8 II.4.9 II.4.10 II.4.11 II.4.12 II.4.13 II.5.1 II.5.2 II.5.3 II.5.4 II.5.5 II.5.6 II.5.7 II.5.8 II.5.9 II.5.10 II.5.11 II.5.12 II.5.13 II.6.1 II.6.2 II.6.3 II.6.4 II.6.5 II.6.6 II.6.7 II.6.8 II.6.9 II.6.10 II.6.11 II.6.12 II.6.13 II.7.1 II.7.2 II.7.3 II.7.4 II.7.5 II.7.6 II.7.7 II.7.8 II.7.9 II.7.10 II.7.11 II.7.12 II.7.13 II.7.14 III.1.1 III.1.2 III.1.3 III.1.4 93 94 III.1.5 IV.1.1 Hearing Impaired Incidence Rate Age Groups Hearing Impaired Age at Onset of Impairment Hearing Impaired Degree of Impairment Hearing Impaired Causes of Impairment Hearing Impaired Educational Status Hearing Impaired Work Activity Status Hearing Impaired Work Activity Status- After Disability Visually Impaired- Magnitude Visually Impaired- Prevalence Rate Visually Impaired Blind Persons State wise Prevalence Rate Visually Impaired Low Vision Persons State wise Prevalence Rate Visually Impaired Prevalence Rate- Age Groups Visually Impaired Incidence Rate Visually Impaired Incidence Rate- Age Groups Visually Impaired Age at Onset of Impairment Visually Impaired Degree of Impairment Visually Impaired Causes of Impairment Visually Impaired Educational Status Visually Impaired Work Activity Status Visually Impaired Work Activity Status After Disability Speech Impairment- Magnitude Speech Impairment- Prevalence Rate Speech Impairment- State wise Prevalence Rate -Males Speech Impairment- State wise Prevalence Rate - Females Speech Impairment- Prevalence Rate- Age Groups Speech Impairment- Incidence Rate Speech Impairment- Incidence Rate- Age Groups Speech Impairment- Age at Onset of Impairment Speech Impairment- Degree of Impairment Speech Impairment- Cause of Impairment Speech Impairment- Educational Status Speech Impairment- Work Activity Status Speech Impairment- Work Activity Status After Disability Mental Impairment- Magnitude Mental Impairment- Prevalence Rate Mental Impairment- Prevalence Rate- Age Groups Mental Retardation- State wise Prevalence Rate Mental Illness- State wise Prevalence Rate Mental Impairment- Incidence Rate Mental Impairment- Incidence Rate- Age Groups Mental Impairment- Age at Onset of Impairment Mental Retardation Degree of Impairment Mental Impairment- Classification, Degree of MR Causes Impairment- Cause of Impairment Education Impairment- Educational Status Mental Impairment- Work Activity Status Mental Impairment- Work Activity Status After Disability Rehabilitation of Persons with Disabilities - Performance of VRCs Performance of District Rehabilitation Centers Aids and Appliance Support to Voluntary Organizations Aids and Appliance Support to Voluntary Organizations- Expenditure Statements Budget Allocations for Welfare of Disability sector in India Delhi Population -2001 95 96 97 98 99 100 101 102 103 IV.1.2 IV.1.3 IV.1.4 IV.1.5 IV.1.6 IV.1.7 IV.1.8 IV.1.9 IV.2.1 104 105 106 107 108 IV.2.2 IV.2.3 IV.2.4 IV.2.5 IV.3.1 109 IV.3.2 110 111 112 113 IV.3.3 IV.3.4 IV.3.5 IV.3.6 Delhi Population Growth- 1941-2001 Delhi- Disabled Persons Projected Magnitude - 2001 Delhi- Disabled Persons Prevalence Rate- 2002 Delhi- Disabled Persons Incidence Rate- 2002 Delhi- Disabled Households Distribution of Disabled Persons Delhi- Disabled Persons Degree of Impairment Delhi- Disabled Persons Education Levels Delhi- Disabled Persons Vocational Training Level DelhiEducation Training Courses Conducted by Government Organizations and NGOs. Delhi- Vocational Courses Conducted Delhi- NGOs Received Assistance from Government Delhi- Aids and Appliances Provided for Disability Sector Delhi- Concessions and Facilities Provided to Disabled Persons. Delhi- NGOs, Voluntary and Government Organization Surveyed March 2003- December 2003 Delhi - NGOs, Voluntary and Government Organization Disability Types, March 2003- December 2003 Delhi Surveyed Organizations, Organizational Status Delhi Surveyed Organizations, Services Provided Delhi Surveyed Organizations, Infrastructure Delhi Surveyed Organizations, Services Required Surveyed- List of Figures and Diagrams S.No. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 Fig. No II.1.1 II.1.2 II.1.3 II.1.4 II.1.5 II.1.6 II.1.7 II.1.8 II.1.9 II.1.10 II.1.11 II.1.12 II.2.1 II.3.1 II.3.2 II.3.3 II.3.4 II.3.5 II.3.6 II.3.7 II.3.8 II.3.9 II.3.10 II.3.11 25 26 II.4.1 II.4.2 Title of the Figure Disabled Persons- Prevalence Rate- Age Groups Disabled Persons- Incidence Rate- Age Groups Disabled Households- Number of Disabled Persons Disabled Persons- Severity of Disability Disabled Persons- Age Distribution Disabled Persons- Social Groups Disabled Persons- Marital Status Disabled Persons- Current Living Status Disabled Persons- Educational Status Disabled Persons- Usual Work Status Disabled Persons- Work Activity Status Disabled Persons- Work Status After Disability Disabled Persons- Types of Disability Locomotor Impaired Persons- Magnitude Locomotor Impaired Persons- Prevalence Rate Locomotor Impaired Persons-Prevalence Rate Age Groups Locomotor Impaired Persons- Incidence Rate Locomotor Impaired Persons-Incidence Rate Age Groups Locomotor Impaired Persons-Age at Onset of Impairment Locomotor Impaired Persons- Degree of Impairment Locomotor Impaired Persons-Causes Locomotor Impaired Persons- Education Status Locomotor Impaired Persons- Work Activity Status Locomotor Impaired Persons- Work Activity Status After Disability Hearing Impaired Persons- Magnitude Hearing Impaired Persons- Prevalence Rate Page 27 28 29 30 31 32 33 34 35 II.4.3 II.4.4 II.4.5 II.4.6 II.4.7 II.4.8 II.4.9 II.4.10 II.4.11 36 37 38 39 40 41 42 43 44 II.5.1 II.5.2 II.5.3 II.5.4 II.5.5 II.5.6 II.5.7 II.5.8 II.5.9 45 46 47 48 49 50 51 52 53 54 55 II.6.1 II.6.2 II.6.3 II.6.4 II.6.5 II.6.6 II.6.7 II.6.8 II.6.9 II.6.10 II.6.11 55 56 57 58 59 60 61 62 63 64 65 66 67 68 69 70 71 72 II.7.1 II.7.2 II.7.3 II.7.4 II.7.5 II.7.6 II.7.7 II.7.8 II.7.9 IV.1.0 IV.1.1 IV.1.2 IV.1.3 IV.1.4 IV.1.5 IV.1.6 IV.3.1 IV.3.2 Hearing Impaired Persons-Prevalence Rate Age Groups Hearing Impaired Persons- Incidence Rate Hearing Impaired Persons-Incidence Rate Age Groups Hearing Impaired Persons-Age at Onset of Impairment Hearing Impaired Persons- Degree of Impairment Hearing Impaired Persons-Causes Hearing Impaired Persons- Education Status Hearing Impaired Persons- Work Activity Status Hearing Impaired Persons- Work Activity Status After Disability Visually Impaired Persons- Magnitude Visually Impaired Persons-Prevalence Rate Age Groups Visually Impaired Persons-Incidence Rate Age Groups Visually Impaired Persons-Age at Onset of Impairment Visually Impaired Persons- Degree of Impairment Visually Impaired Persons-Causes Visually Impaired Persons- Education Status Visually Impaired Persons- Work Activity Status Visually Impaired Persons- Work Activity Status After Disability Speech Impaired Persons- Magnitude Speech Impaired Persons- Prevalence Rate Speech Impaired Persons-Prevalence Rate Age Groups Speech Impaired Persons- Incidence Rate Speech Impaired Persons-Incidence Rate Age Groups Speech Impaired Persons-Age at Onset of Impairment Speech Impaired Persons- Degree of Impairment Speech Impaired Persons-Causes Speech Impaired Persons- Education Status Speech Impaired Persons- Work Activity Status Speech Impaired Persons- Work Activity Status After Disability Mentally Impaired Persons- Magnitude Mentally Impaired Persons-Prevalence Rate Age Groups Mentally Impaired Persons-Incidence Rate Age Groups Mentally Impaired Persons-Age at Onset of Impairment Mentally Impaired Persons- Degree of Impairment Mentally Persons-Causes Mentally Persons- Education Status Mentally Persons- Work Activity Status Mentally Persons- Work Activity Status After Disability Delhi- Population Growth- 1901-2001 Delhi- Disability Types - 2002 Delhi- Disability Prevalence Rate- 2002 Delhi- Disability Incidence Rate 2002 Delhi- Disability Degree of Impairment 2002 Delhi- Disabled Persons, Education Status 2002 Delhi- Disabled Persons, Vocational Training Status 2002 Delhi- Disability Organizations Surveyed- 2003 Delhi- Disability Organizations Surveyed- Status- 2003 List of Maps S.No. 1 2 3 4 5 6 7 8 9 9-A 10 11 12 13 14 15 16 17 18 Map.No II.1.0 II.1.1 II.1.2 II.1.3 II.1.4 II.3.1 II.3.2 II.4.1 II.4.2 II.5.0 II.5.1 II.5.2 II.6.1 II.6.2 II.7.1 II.7.1 III.1.1 III.1.2 IV.3.1 Title of the Map Page No. India- States India - Disabled Persons- Prevalence Rate- Males India - Disabled Persons- Prevalence Rate- Females India - Disabled Persons- Incidence Rate- Males India - Disabled Persons- Incidence Rate- Females India- Locomotor Impaired - Prevalence Rate- Males India- Locomotor Impaired - Prevalence Rate- Females India- Hearing Impaired - Prevalence Rate- Males India- Hearing Impaired - Prevalence Rate- Females India- Visually Impaired- Prevalence Rate-1991 India - Blind Persons - Prevalence Rate- 2002 India - Low Vision Persons - Prevalence Rate- 2002 India- Speech Impaired - Prevalence Rate- Males India- Speech Impaired - Prevalence Rate- Females India- Mentally Retarded - Prevalence Rate- 2002 India - Mentally Ill- Prevalence Rate- 2002 India- National Institutes for Disability Sector India- Regional and District Institutes for Disability Sector Delhi- Location of Surveyed NGOs/ Government/ Voluntary Organizations Preface The present study examines the conceptual and theoretical aspects of disability sector in India with a special focus on magnitude, prevalence rates, incidence rates, characteristics and composition of disabled person in India. Special focus has been given to identify available services and facilities for disabled persons through government and non-government organizations with special reference to Delhi Metropolitan region. The report has been divided into six parts excluding the executive summary, which presents main conclusions of the report for each part and also presents major recommendation of the report. The lay out of the report is substantiated with the help of tables, maps, figures and diagrams for easy visual understanding. Part-I examines the definitional and conceptual aspects of disability. It identifies various disability type groups based on specific physical, sensory and learning characteristics. It also attempts to trace and analyses international initiatives undertaken for the welfare of disability sector during last 50 years. The last section of this part examines national initiatives through legislation and other affirmative actions and initiatives to focus disability agenda for pro-active measures. Part-II has been divided into seven sections. Each section examines magnitude, composition and characteristics of different types of disability / impairments. The disabilities/ impairments covered are all disabled, locomotor impaired, hearing impaired, vision impaired, speech impaired and mentally impaired. It examines the NSSO data collected for the disabled person through a sample surveys during 47th and 58th round in 1991 and 2002 respectively. The analysis includes state wise, gender wise and rural/ urban distribution of disabled persons depicting their magnitude, prevalence rates, incidence rate, degree of impairment, causes for impairment and a in depth analysis of demographic, social and economic characteristics of the disabled persons Part-III has been divided into three sections. It examines government services for the disabled persons in terms of developing national and regional institutes to support and create conducive environment for equal opportunities for disabled persons. Part-III also examines services and facilities provided by these national and regional institutes to disabled persons in India. The budget allocations for the disability sector welfare have also been presented in this section. Last section examines the concessions and other benefits provided to disabled persons for creating equal opportunities for their integration. It also analyses the status of implementation of the PWD-Act 1995 provisions in the states in India and by the central government. Part-IV examines services and other facilities available for disabled person in the Delhi Metropolitan region. The analysis has been attempted both though primary and secondary sources of information. A details field survey was conducted in Delhi selecting 83 NGOs and voluntary organizations and 63 beneficiaries. The respondents included NGOs, Government organization personnel as well as disabled/-impaired persons seeking support from these organizations. Detailed analysis of the existing services as well as required services has been attempted on the basis of the field survey. Last section of the part documents the 'Good Practice- Initiatives' of NGOs and government organizations providing support to disabled persons in Delhi region. Part-V of the report presents the broad conclusions and recommendations of the report. The recommendations are suggested based on the field survey data analysis, discussions with target groups and stakeholders and from the deliberations of the seminar organised in Delhi, where a large number of NGOs, government officials, target groups and other stakeholders were present. A detailed list of references, literature reviewed and bibliography scanned for the study purpose is given in Part-VI of the report. These references, disability data and bibliography has been identified in libraries visited in Delhi, web search engines through internet and material collected from government departments and NGOs offices located in Delhi. Last Part of the report documents annexes detailing NGOs working for Disability welfare in Delhi, NGOs and beneficiaries selected for a detailed field survey, field questionnaires used for the survey and a report on the seminar entitled " Services for Differently Abled Persons in India". The seminar was organised as a part of the research report to provide insights about disability sector in India through wider participation from stakeholders and target groups. Part-I Disability - Definition, Types and International and National Initiatives Defining Disability: Defining disability is difficult to accommodate the expectations of all disabled groups. There are hundreds of different disabilities and there are, as many causes for these disabilities. Some people are born with disabilities; others become disabled later on in their lives. Some disabilities exhibit themselves only periodically like fits and seizures; others are constant conditions and are life-long. The severity of some stays the same, while others get progressively worse like muscular dystrophy and cystic fibrosis. Some are hidden and not obvious like epilepsy or haemophilia (impairment of blood clotting mechanism). Some disabilities can be controlled and cured while others still baffle the experts. Thus, finding a consensus on the different and frequently varying definitions of disabilities, whether sophisticated or practical, has never been easy. Some include total or partial impairment of senses and physical and intellectual capacities while defining disability. Others refer to a handicap or deviation of a social nature, injury or illness or incapacities to accomplish physiological functions or to obtain or keep employment. These definitions also reflect the consequences for the individual - cultural, social, economic and environmental- that stem from the disability. Helander1: Helander gave the simplest and may be the initial definition of a disabled person. "A person who in his/her society is regarded as disabled, because of a difference in appearances and/or behaviour." In most instances, a disabled person has functional limitations and/or activity restrictions. A 'functional limitation' disability may be defined as 'specific reductions in bodily functions that are described at the level of the person'. While 'Activity restriction' disability may be defined as 'specific reductions in daily activities that are described at the level of the person'. American Disability Act 1990 (ADA) ADA defines individuals with a physical or mental impairment that substantially limits at least one major life activity, individuals with a history of such impairment, and people who are regarded by others or perceived as having such impairment. This definition protect people with epilepsy, diabetes, mental health conditions, amputees, and others who are able to mitigate the effects of their impairments but nonetheless encounter discrimination in the workplace and other settings because of fears, myths and stereotypes of individual employers and other covered entities. ADA has categorised disability physical and mental disability groups: Physical disability: It includes . . . "Having any physiological disease, disorder, condition, cosmetic disfigurement, or anatomical loss that . . . affects one or more of the following body systems: neurological, immunological, musculo-skeletal, special sense organs, respiratory, including speech organs, cardiovascular, reproductive, digestive, genitourinary, hemic and lymphatic, skin, and endocrine [and] limits a major life activity . . .. Having a record or history of a disease, disorder, condition, cosmetic disfigurement, anatomical loss, or health impairment . . . which the employer knows . . .. Being regarded or treated . . . as having, or having had, any physical condition that makes achievement of a major life activity difficult. Being regarded or treated . . . as having, or having had, a disease, disorder, condition, cosmetic disfigurement, anatomical loss, or health impairment that has no present disabling effect but may become a physical disability"3. Mental disability: It includes . . . "Having any mental or psychological disorder or condition, such as mental retardation, organic brain syndrome, emotional or mental illness, or specific learning disabilities, that limits a major life activity . . . . Having a record or history of a mental or psychological disorder or condition . . . which is known to the employer . . .. Being regarded or treated by the employer or other entity covered by this part as having, or having had, any mental condition that makes achievement of a major life activity difficult. Being regarded or treated . . . as having, or having had, a mental or psychological disorder or condition that has no present disabling effect, but that may become a mental disability . . ."4 Australia Disability Discrimination Act, (ADDA) 1972 Disability in relation to a person, means a. b. c. d. e. f. g. Total or partial loss of the person's bodily or mental functions; or Total or partial loss of a part of the body; or The presence in the body of organisms capable of causing disease or illness; or The presence in the body of organisms causing disease or illness; or The malfunction, malformation or disfigurement of a part of the person's body; or A disorder or malfunction that results in the person learning differently from a person without the disorder or malfunction; or A disorder, illness or disease that affects a person's thought processes, perception of reality, emotions or judgment or that results in disturbed behaviour and includes a disability that: i. Presently exists; or ii. Previously existed but no longer exists; or iii. May exist in the future; or iv. Is imputed to a to a person. British Disability Discrimination Act (BDDA), 1995 Disability is a physical or mental impairment, which has a substantial and long-term adverse effect on his ability to carry out normal day-to-day activities. In order to apply durability test, the British Act uses three different terms: loss of faculty, disability and disablement. These are meant to be separate concepts. Loss of FacultyLoss of faculty is any pathological condition or any loss or reduction of normal physical or mental functions of an organ or part of the body. A loss of faculty in itself may not be a disability but is an actual cause of one or more disabilities, e.g., the loss of one kidney. DisabilityA 'disability' means an inability to perform a normal bodily or mental process. It could either be complete inability to do something (such as walking) or it can be partial inability to do something (such as one can lift weights but not heavy ones). Disablement- It is the sum total of all the separate disabilities an individual may suffer from. It means an overall inability to perform the normal activities of life and the loss of health, strength and power to enjoy a normal life. While assessing an individual his/her physical and mental condition, inconvenience, genuine embarrassment or anxieties are taken into account. India: Persons with Disabilities Act 1995 (PWD-Equal opportunities, Protection of Rights and Full Participation) Disability is defined a person suffering from not less than forty per cent of any disability as certified by a medical authority. The disabilities identified are; blindness, low vision, cerebral palsy, leprosy, leprosy cured, hearing impairment, locomotor disability, mental illness and mental retardation as well as multiple disabilities. The National Sample Survey Organization (NSSO), India: The NSSO that conducted survey of persons with disabilities in 1981, 1991 and 2002 in India, considered disability as " Any restriction or lack of abilities to perform an activity in the manner or within the range considered normal for human being". It excludes illness /injury of recent origin (morbidity) resulting into temporary loss of ability to see, hears, speak or move. International Labour Organization (ILO): The ILO in its Vocational Rehabilitation and Employment (Disabled Persons) Convention defines a disabled person as an individual whose prospects of securing, retaining and advancing a suitable employment are substantially reduced as a result of duly recognised physical or mental impairment. The Declaration on the Rights of Disabled Persons, the term " Disabled Person" means, " Any person unable to ensure by himself or herself, wholly or partly, the necessities of a normal individual and / or social life as a result of deficiency, either congenital or not, in his or her physical or mental capabilities". United Nations: Standard rules on the Equalisation of Opportunities for Persons with Disabilities, 1994 'Disability' summarizes a great number of different functional limitations occurring in any population in any country of the world. People may be disabled by physical, intellectual or sensory impairment, medical conditions or mental illness. The term 'handicap' means the loss or limitation of opportunities to take part in the life of the community on an equal level with others. It describes the encounter between the persons with a disability and the environment. The purpose of this term is to emphasize the focus on the shortcomings in the environment and in many organised activities in society, e.g., information, communication and education, which prevent persons with disabilities from participating on equal terms. World Health Organization (WHO): International Classification of Impairments, Disabilities and Handicaps (ICIDH) in 1980. The ICIDH provides a conceptual framework for disability with three parts: Impairment is "any loss or abnormality of psychological, physiological, or anatomical structure or function". Impairments are disturbances at the level of the organ, which includes defects in or loss of a limb, organ or other body structure, as well as defects in or loss of a mental function. Examples of impairments include blindness, deafness, loss of sight in an eye, paralysis of a limb, amputation of a limb; mental retardation, partial sight, loss of speech, mutism, cerebral palsy and learning difficulties. Disability is a "restriction or lack (resulting from an impairment) of ability to perform an activity in the manner or within the range considered normal for a human being". It describes a functional limitation or activity restriction caused by impairment. Disabilities are descriptions of disturbances in function at the level of the person. Examples of disabilities include difficulty in seeing, speaking or hearing; learning, difficulty in moving or climbing stairs; difficulty in grasping, reaching, bathing, eating, and toileting etc; Handicap is a "disadvantage for a given individual, resulting from an impairment or disability, that limits or prevents the fulfillment of a role that is normal (depending on age, sex and social and cultural factors) for that individual". The term is also a classification of "circumstances in which disabled people are likely to find themselves". Handicap describes the social and economic roles of impaired or disabled persons that place them at a disadvantage compared to other persons. These disadvantages are brought about through the interaction of the person with specific environments and cultures. Examples of handicaps include being bedridden or confined to home; being unable to use public transport; being socially isolated, being forced to remain illiterate. World Health Organization: International Classification of Impairments, Disabilities and Handicaps (ICIDH) in 2001. The document, referred to as the ICIDH-2, is officially titled the "International Classification of Functioning and Disability," or ICF . Under this new system, the three concepts of impairment, disability and handicap have been replaced by two concepts "Body functions and structures" (replacing "impairment"); and "Activities and participation" (replacing "handicap") - which are thoughts to extend the prior categories to permit the description of positive as well as negative experiences. The prior concept of "disability," or "functional" abilities or inabilities, is now conceived of as an umbrella concept applicable to either the body perspective, or to the individual and society perspective. The new system explicitly contemplates an assessment of "environmental factors," including the physical environment, the social environment and the impact of attitudes, and of "personal factors," which correspond to the personality and characteristic attributes of an individual. Disability types: Disabled people do not form a homogenous group. They may be, the physically disabled, mentally retarded, the visually, hearing and speech impaired, those with restricted mobility or with so-called "medical disabilities" and learning disabilities. They can broadly be classified as Physical and Communication, Mental, Learning and Medical disabilities. I. Physical and Communication Disabilities: Physical and Communication disabilities involve either loss of vision, physical movement, communication skills or a weakness or change in normal motor control. Some physical disabilities are present at birth (congenital) or are acquired due to illness, accident, or unknown causes. Loss of vision leads to complete blindness or low vision, loss of movement is often caused by spinal cord injury (damage to the nervous system) or by physical trauma such as severe fracture, burns or the amputation of a limb. One of the most common physical disabilities in young people is, cerebral palsy (CP). It produces disturbances of voluntary motor control ranging from clumsy and awkward movements to little or no coordinated movement. Individuals with CP can have related speech problems, as well as impaired hearing or vision. Other conditions such as muscular dystrophy, multiple sclerosis and amyotrophic lateral sclerosis, produce similar types of changes in physical functioning. a. Visual impairment (VI): Blindness: 'Blindness' refers to a condition where a person suffers from any of the following conditions, namely -total absence of sight; or visual acuity not exceeding 6/60 or 20/200 (snellen) in the better eye with correcting lenses; or limitation of the field of vision subtending an angle of 20 degrees or worse. Person with low vision - 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. b. c. Hearing Impairment (HI) Whose sense of hearing is non-functional for ordinary purposes in life? They do not hear/understand sound at all, even with amplified speech. The cases included in this category will be those having hearing loss of more than 60 decibels in the better ear (profound impairment) in the conversational range of frequency or total loss of hearing in both ears. Locomotor Impairment (LC). Locomotor impairment is disability of the bones, joint or muscles leading to substantial restriction of the movement of the limbs or a usual form of cerebral palsy and autism. Some common conditions giving raise to locomotor disability could be poliomyelitis, cerebral palsy, autism, amputation, injuries of spine, head, soft tissues, fractures, muscular dystrophies etc. d. II. Orthopedic disability: A person inability to execute distinctive activities associated with moving both himself and objects, from place to place, and such inability resulting from affliction of either bones, joints, muscles or nerves. It could be poliomyelitis, amputation, injuries of spine, head, soft tissues, fractures, muscular dystrophies etc. Cerebral Palsy: A condition of Motor dysfunction of a person resulting from brain insult or injuries occurring in the pre-natal, peri- natal or infant period of development that affect movement control. The injury may be a brain infection (bacterial meningitis, viral encephalitis) or head injury before birth or following an accident. Erb's palsy, Brachial Plexus Palsy, or Shoulder Dystocia: A condition when excessive lateral traction is applied to the fetal neck region during delivery. This can cause the Childs nerves to be torn, resulting in a limp arm. Tearing of these nerves can cause permanent paralysis of the arm. Autism: Autism is a complex developmental disability that typically appears during the first three years of life. It is the result of a neurological disorder that affects the functioning of the brain. It is a developmental disability typically affecting the processing, integrating, and organizing of information that significantly impacts communication, social interaction, functional skills, and educational performance. Leprosy or 'Leprosy cured person' means any person who has been cured of leprosy but is suffering from Loss of sensation in hands or feet as well as loss of sensation and paresis in the eye and eye-lid but with no manifest deformity; Manifest deformity and paresis but having sufficient mobility in their hands and feet to enable them to engage in normal economic activity; Extreme physical deformity as well as advanced age that prevent him from undertaking any gainful occupation, and the expression 'leprosy cured' shall be construed accordingly. Mental, psychological illness and Mental Retardation: a. b. Mental, psychological Illnesses: These encompass Schizophrenia, anxiety disorders and depressive disorders. Schizophrenia is a highly complex disorder, which is caused due to a series of chemical changes in the brain. It usually occurs between the age groups of 15-25 years and is characterized by fragmented thoughts followed by an inability to process information. The condition affects the individual's family, professional and social life making him incapable of functioning normally. Surprisingly their intelligence is not affected and many of them are capable of leading partially normal life if they follow their regular pattern of medication and rehabilitation programmes such as those offered by half-way-homes. Mental Retardation: The definition includes 'any person who is unable to ensure himself/herself, wholly or partly, the necessities of a normal individual or social life including work, as a result of deficiency in his/her physical or mental capability'. A condition characterized by abnormal brain development in the womb not corresponding with normal physical growth. Their learning ability, reasoning power and judgment all develop at a slower pace. Accidents, poisoning, or illness after birth can be a cause for mental retardation. Many of the mentally retarded people are able to participate in activities with non-disabled people given an appropriate adaptation and support. Others may require a long-term structured programme. With adequate training and education such persons can be more self-reliant citizens. They can be found holding non-skilled or semi skilled jobs and can be made to effectively integrated into the social structure. Mental retardation is divisible into the following four categories. 1. Mild retardation IQ - 50 - 70 2. Moderate retardation IQ - 35 - 49 3. Severe retardation IQ - 20 - 34 4. Profound retardation IQ under 20 Learning Disabilities: It is a disorder, which affects the basic psychological processes of understanding or using written or spoken language. This disorder affects development of language, speech, reading and associated communication skills needed for social interaction. These children have deviant activity level, average or above average intelligence with perceptual disorders, problems in reading, writing, spelling & arithmetic, delayed or slow development of speech articulation, short attention span, frequent changes in mood, low self esteem, low or below average social competence, impulsive, problems in motor activities and spatial organization, poor temporal concepts, passive, lacking strategies for tackling academic problems, having inadequate grasp of what strategies are available for problem solving and do not believe in their abilities. Conditions such as brain injury, minimal brain dysfunction, dyslexia, and developmental aphasia are examples of learning disabilities. o o o o Dyslexia: Affect persons ability to acquire, process, and/or use either, spoken, read, written or nonverbal information (organization/planning, functional literacy skills, memory, reasoning, problem solving, perceptual skills) or in other words in short- difficulty with language in its various uses (not always reading). Dysgraphia: Difficulty with the act of writing both in the technical as well as the expressive sense. There may also be difficulty with spelling. Dyscalculia: Difficulty with calculations Attention Deficit and Hyperactivity Disorder (ADHD) Multiple Disabilities: A combination of two or more disabilities as defined in clause (i) of section 2 of the Person with disabilities (Equal Opportunities, Protection of Rights and Full Participation) Act 1995 namely Blindness/low vision Speech and Hearing impairment Locomotor disability including leprosy cured Mental retardation and Mental illness. Medical Disaisabilities (MD): A medical disability can be defined as a condition that requires intervention such as medical treatment, prescription drugs, and/or accommodation to help a person participate in life's activities. Medical disabilities may be acute or chronic, visible or invisible, and the type of support needed is diverse. The chronic health problems include fibromyalgia, chronic fatigue syndrome, arthritis, kidney disease, allergies, cardiovascular problems, cancer, diabetes, and HIV infections, as well as respiratory and gastro-intestinal disorders. Recognizing medical conditions may be difficult because many are "hidden". The primary diagnosis may be accompanied by secondary impairments in mobility, vision, hearing, speech, or coordination depending on the nature and/or progression of the condition. Medical disabilities can be classified into: Autoimmune Illness: It includes fibromyalgia, chronic fatigue syndrome, rheumatoid arthritis, asthma and lupus. A lowered immunity can result in frequent illnesses. Patients can experience flare-ups, side effects of medication, or hospitalisation. Blood serum disorders: It includes haemophilia, thalassemia, sickle cell anaemia, HIV/AIDS, and other disorders. Blood serum disorders can be characterized by severe crisis periods with extreme pain and other complications, which may necessitate hospitalisation. Epilepsy: It is a disorder of the central nervous system, which results in a seizure. For many adults, epileptic seizures are largely controlled by anti-convulsion medication. There are four major kinds of seizures, distinguished by the degree of convulsion and the extent to which the person is conscious. Grand mal epilepsy involves sudden and violent convulsions and loss of consciousness, whereas Petit mal epilepsy is milder and involves little or no loss of consciousness. The person may stop what he/she is doing and stare momentarily. Cancers: It can occur in almost any organ system of the body, the systems and particular disabling effects will vary greatly from one person to another. People may experience visual problems, lack of balance and coordination, joint pain, backaches, headaches, abdominal pain, drowsiness, lethargy, difficulty in breathing and swallowing, weakness, bleeding, or anaemia. The primary treatments for cancer can cause additional effects such as violent nausea, drowsiness, and fatigue. Medical treatment can result in amputation, paralysis, sensory deficits, and language and memory problems. Cystic Fibrosis (CF): It is a disease affecting the cells lining the pancreas, small intestines, sweat glands, and lungs. CF's respiratory symptoms are chronic and eventually lead to fatal lung infections. Muscular Dystrophy: It refers to a group of hereditary, progressive disorders that most often occur with young people, producing degeneration of voluntary muscles of the trunk and extremities. Atrophying of muscles results in chronic weakness and fatigue and may cause respiratory or cardiac problems. Walking, if possible, is slow. Multiple Sclerosis: is a progressive disease of the central nervous system, characterized by a decline of muscle control. Symptoms range from mild to severe and may include blurred vision, legal blindness, tremors, weakness or numbness in limbs, unsteady gait, paralysis, slurred speech, mood swings, or attention deficits. Periodic remissions are common and may last from a few days to several months as the disease continues to progress. Drug and Alcohol Abuse: Persons who are in treatment programs experience psychological problems such as depression, anxiety, or low self-esteem, as well as cognitive deficits such as impaired concentration or short-term memory. International Initiatives for Disabled: From its early days the United Nations has sought to advance the status of disabled persons and to improve their lives. The concern of the United Nations for the well-being and rights of disabled persons is rooted in its founding principles, which are based on human rights, fundamental freedoms and equality of all human beings. As affirmed by the United Nations Charter, the Universal Declaration of Human Rights, International Covenants on Human Rights and related human rights instruments, persons with disabilities are entitled to exercise their civil, political, social and cultural rights on an equal basis with non-disabled persons. The contribution of United Nations specialized agencies to advance the situation of disabled persons is noteworthy: the United Nations Educational, Scientific and Cultural Organization (UNESCO) by providing special education; the World Health Organization (WHO) by providing technical assistance in health and prevention; the United Nations International Children's Fund (UNICEF) by supporting childhood disability programmes and providing technical assistance in collaboration with Rehabilitation International (a non-governmental organization); the International Labour Organization (ILO) by improving access to the labour market and increasing economic integration through international labour standards and technical cooperation activities. The international initiatives have been identified in several phases in view of the changing approaches of understanding and measures undertaken for their inclusion in the society. PhaseI, 1945-1955 In the 1940s and 1950s, the United Nations promoted Welfare perspective on disability, focusing on rights of disabled through a range of social welfare approaches. Advocating prevention and rehabilitation issues followed several measures vigorously. The Social Commission of the United Nations provided assistance to Governments in disability prevention and the rehabilitaation of disabled persons through advisory missions, workshops for the training of technical personnel and the setting up of rehabilitation centres. PhaseII, 1955-69 This phase witnessed a shift from a welfare perspective to one of social welfare. A re-evaluation of policy in the 1960s led to de-institutionalization and spurred a demand for fuller participation by disabled persons in an integrated society. Operational activities in the field of disability changed through implementation of various United Nations programmes on prevention and rehabilitation. The United Nations in its Article 19 addressed the provision of health, social security, and social welfare services for all persons, aiming at the rehabilitation of the mentally and physically disabled so as to facilitate their integration into society. PhaseIII, 1970-75 In the 1970s, the growing international concern with human rights for persons with disabilities was specifically addressed by the General Assembly in the Declaration on the Rights of Mentally Retarded Persons. The Right of Mentally Retarded Persons Declaration stipulates that mentally retarded persons are accorded the same rights as other human beings, as well as specific rights corresponding to their needs in the medical, educational and social fields. Emphasis was put on the need to protect disabled persons from exploitation and provide them with proper legal procedures. In 1975 the Declaration on the Rights of Disabled Persons proclaims the equal civil and political rights of disabled persons. This Declaration sets the standard for equal treatment and access to services, which help to develop capabilities of persons with disabilities and accelerate their social integration. PhaseIV, 1976-1980 The General Assembly recommended that all Member States take into account the recommendations outlined in the Declaration on the Rights of Disabled Persons when formulating policies, plans and programmes. It also proclaims 1981 as International Year for Disabled Persons, stressing that the Year should be devoted to fully integrating disabled persons into society and encouraging relevant study and research projects to educate the public on the rights of disabled persons. It called for a plan of action at the national, regional and international levels, with an emphasis on equalization of opportunities, rehabilitation and prevention of disabilities. In 1978 The Secretary-General establishes the intergovernmental Advisory Committee for the International Year of Disabled Persons. Phase V, 1980-82 The International Year of Disabled Persons, 1981, was celebrated with numerous programmes, adopting recommendations of research projects, policy innovations and other rehabilitation programmes. Many conferences and symposiums were held during the Year, including the First Founding Congress of Disabled People International, held in Singapore from 30 November to 6 December. In 1982, the General Assembly took a major step towards ensuring effective follow-up to the International Year by adopting, on 3 December 1982, the World Programme of Action concerning Disabled Persons. The World Programme transformed the disability issue from a "social welfare" issue to that of integrating the human rights of persons with disabilities in all aspects of development processes. The Programme restructured disability policy into three distinct areas: o o o Prevention; Rehabilitation; and Equalization of opportunities. In a broad sense, implementation would entail long-term strategies integrated into national policies for socio-economic development, preventive activities that would include development and use of technology for the prevention of disablement, and legislation eliminating discrimination regarding access to facilities, social security, education and employment. At the international level, Governments were requested to cooperate with each other, the United Nations and nongovernmental organizations. Together, the Programme and the International Year had launched a new era--one that would seek to define "handicapped" as the relationship between persons with disabilities and their environment. It was imperative that the barriers created by society to full participation by persons with disabilities be removed. Phase VI 1983-92 In the World Programme of Action, the General Assembly proclaimed 1983-1992 the United Nations Decade of Disabled Persons . It prompted a flurry of activity designed to improve the situation and status of the disabled. Emphasis was placed on raising new financial resources, improving education and employment opportunities for the disabled, and increasing their participation in the life of their communities and country. The Sub-Commission on Prevention of Discrimination and Protection of Minorities had disabled persons in international human rights discourse since its establishment. In appointed Leandro Despouy of Argentina as Special Rapporteur to study the connection human rights violations, violations of fundamental human freedoms and disability. He report to the Sub-Commission on the particular human rights situation of disabled recommended the establishment of an international ombudsman in 1991. included 1984, it between biannual persons At this juncture, the General Assembly of the United Nations noted with concern the plight of disabled persons in some countries and asked member countries to ensure that persons with disabilities would enjoy the same rights to employment as all other qualified citizens and that the United Nations itself would declare employment opportunities open to all persons, regardless of sex, religion, ethnic origin or disability. In August 1987, a mid-decade review of the United Nations Decade of Disabled persons was conducted at a global meeting of experts in Stockholm, Sweden. The meeting recommended the importance of recognizing the rights of persons with disabilities. Since the pace of progress during the first five years had not been as fast as initially expected, the experts agreed that the disability issues should be further addressed within a wider interdisciplinary context--namely, a comprehensive well-coordinated information and evaluation campaign; establishment of a data base on disability; and creation of technical cooperation programmes. On 17 December 1991, the General Assembly adopted the Principles for the Protection of Persons with Mental Illness and for the Improvement of Mental Health Care. The twenty-five principles define fundamental freedoms and basic rights for these people. They deal with, inter alia, the right to life in the community, the determination of mental illness, provisions for admission to treatment facilities, and the conditions of mental health facilities. They serve as a guide to Governments, specialized agencies and regional and international organizations, helping them facilitate investigation into problems affecting the application of fundamental freedoms and basic human rights for persons with mental illness. On 16 December 1992, the General Assembly appealed to Governments to observe 3 December of each year as International Day of Disabled Persons. The Assembly further summarized the goals of the United Nations regarding disability and asked the Secretary-General to move from consciousness-raising to action, placing the Organization in a catalytic leadership role, which would place disability issues on the agendas of future world conferences. A significant outcome of the United Nations Decade of Disabled Persons (1983-1992) was the adoption of the Standard Rules on the Equalization of Opportunities for Persons with Disabilities by the forty-eighth session of the General Assembly in 1993. The Standard Rules are an international instrument with a human rights perspective for disability-sensitive policy design and evaluation as well as for technical and economic cooperation. Phase VII, 1993-2002 The Vienna Declaration and Programme of Action (1993) states that place of disabled person is everywhere. It states that these persons should be guaranteed equal opportunity through the elimination of all socially determined barriers, be they physical, financial, social or psychological, which exclude or restrict their full participation in the society. In the same year, the Economic and Social Council endorsed the proclamation of 1993-2002 as Asian and Pacific Decade of Disabled Persons, a decision taken by the Economic and Social Commission of Asia and the Pacific, in order to implement effectively the World Programme of Action in the Asian and Pacific region. The United Nations conducted a comprehensive comparative study of global disability policies and programmes in 1997 and issued it as a Report of the Secretary-General, "Review and appraisal of implementation of the World Programme of Action concerning Disabled Persons." This study indicated that a broad human rights framework must be further developed and established for disability policies and programmes to promote social, economic and cultural rights as well as the civil and political rights of persons with disabilities. Major international conferences and summits that were organized during the first half of the 1990s on a range of development agendas adopted action plans and programmes in which participation, inclusion and improved well being of persons with disabilities were accorded a special emphasis. Most recently, the fifty-sixth session of the Commission on Human Rights adopted resolution 2000/51 of 25 April 2000, entitled "Human Rights of Persons with Disabilities." The resolution invites treaty bodies and their Special Rapporteurs to include the rights of persons with disabilities in the monitoring of the implementation of the relevant human rights instruments. The resolution also urges Governments to include the question of human rights of persons with disabilities in their reporting requirements under the existing human rights treaties and calls for cooperation with the Special Rapporteur on Disability of the Commission for Social Development and the High Commissioner for Human Rights to examine possible measures to strengthen the protection and monitoring of the human rights of persons with disabilities. World Programme of Action Concerning Disabled Persons: Persons with disabilities often are excluded from the mainstream of the society and denied their human rights. Both de jure and de facto discrimination against persons with disabilities have a long history and take various forms. They range from invidious discrimination, such as the denial of educational opportunities, to more subtle forms of discrimination, such as segregation and isolation because of the imposition of physical and social barriers. Effects of disability-based discrimination have been particularly severe in fields such as education, employment, housing, transport, cultural life and access to public places and services. This may result from distinction, exclusion, restriction or preference, or denial of reasonable accommodation on the basis of disablement, which effectively nullifies or impairs the recognition, enjoyment or exercise of the rights of persons with disabilities. However, the experiences from developed societies have indicated that provision of affirmative social, cultural, economic, legal and healthcare actions and support through barrier free environmental setting with the help of scientific, technical aids and appliances have significantly reduced their handicaps and paved the way for their smooth inclusion, interaction and adaptation with the society and surroundings. Social model of disability views handicaps more as a consequence of oppression, prejudice and discrimination by the society. Therefore a view that handicap is made, and not acquired by a majority of impairments and disabilities are gaining recognition globally. Despite some progress in terms of legislation over the past decades, such violations of the human rights of persons with disabilities have not been systematically addressed in many societies. Most disability legislation and policies are based on the assumption that disabled persons simply are not able to exercise the same rights as non-disabled persons. Consequently the situation of persons with disabilities often will be addressed in terms of rehabilitation and social services. A need exists for more comprehensive legislation to ensure the rights of disabled persons in all aspects - political, civil, economic, social and cultural rights - on an equal basis with persons without disabilities. Appropriate measures are required to address existing discrimination and to promote thereby opportunities for persons with disabilities to participate on the basis of equality in social life and development. Attitude towards Disability: Leeds Metropolitan University identifies disability can be negotiated in two way, one leads towards their inclusion and the other leads to their exclusion. The two major ways are: Social or Barrier Model: It views that disabilities often lead to o o o Impairments and chronic illness which often pose real difficulties for disabled people but they are not the main problems It is the 'barriers' which exist in society that create the main problems The three main barriers are: Environment - this includes inaccessible buildings and services, inaccessible communication and language Attitudes - this includes stereotyping, discrimination and prejudice Organisations - this includes procedures and practices, which are inflexible. These barriers 'disable' people with impairments. If these barriers are taken away or reduced the disabled people will be able to take a full and active part in society. Medical Model of Disability: It is the traditional view that views: o o o o Disability is caused by mental and/or physical impairment The individual is 'impaired' and the individual has a problem The focus of the medical profession is to 'cure' or alleviate the effects of impairments Disabled people need to be treated, changed, improved and made more 'normal' to fit in with society The approaches of attitudes towards disabled are explained in the following model, which leads towards inclusion or exclusion depending upon the attitude towards the disabled in the society. Constitutional Framework in India The Constitution of India applies uniformly to every legal citizen of India, whether they are healthy or disabled in any way (physically or mentally) and guarantees a right of justice, liberty of thought, expression, belief, faith and worship and equality of status and of opportunity and for the promotion of fraternity. To safeguard the interests of the disadvantaged sections of the Society, the Constitution of India guarantees that no person will be denied `equality' before the law (Article 14 of the Indian Constitution). Relevant Articles in Indian Constitution providing constitutional guarantees to all including disabled are: Article 15(1): It enjoins on the Government not to discriminate against any citizen of India (including disabled) on the ground of religion, race, caste, sex or place of birth. Article 15 (2): It states that no citizen (including the disabled) shall be subjected to any disability, liability, restriction or condition on any of the above grounds in the matter of their access to shops, public restaurants, hotels and places of public entertainment or in the use of wells, tanks, bathing places (ghats), roads and places of public resort maintained wholly or partly out of government funds or dedicated to the use of the general public. Article 17: No person including the disabled irrespective of his belonging can be treated as an untouchable. It would be an offence punishable in accordance with law. Article 21: Every person including the disabled has his life and liberty guaranteed. Article 23: There can be no traffic in human beings (including the disabled), and beggar and other forms of forced labour is prohibited and the same is made punishable in accordance with law. Article 29(2): The right to education is available to all citizens including the disabled. No citizen shall be denied admission into any educational institution maintained by the State or receiving aid out of State funds. Article 32: Every disabled person can move the Supreme Court of India to enforce his fundamental rights and the rights to move the Supreme Court. Legal Framework for Disabled: I. Design Act 1911: Under the Designs Act, 1911 which deals with the law relating to the protection of designs any person having jurisdiction in respect of the property of a disabled person (who is incapable of making any statement or doing anything required to be done under this Act) may be appointed by the Court under Section 74, to make such statement or do such thing in the name and on behalf of the person subject to the disability. The disability may be lunacy or other disability. II. Succession Act, 1956: It applies to all Hindus. It provides that physical disability or physical deformity would not disentitle a person from inheriting ancestral property. Similarly, in the Indian Succession Act, 1925 that applies in the case of interstate and testamentary succession, there is no provision, which deprives the disabled from inheriting an ancestral property. The position with regard to Parsis and the Muslims is the same. In fact a disabled person can also dispose his property by writing a will provided he understands the import and consequence of writing a will at the time when a will is written. For example, a person of unsound mind can make a Will during periods of sanity. Even blind persons or those who are deaf and dumb can make their Wills if they understand the import and consequence of doing it. III. Marriage Acts: The rights and duties of the parties to a marriage whether in respect of disabled or non-disabled persons are governed by the specific provisions contained in different marriage Acts, such as the Hindu Marriage Act, 1955, the Christian Marriage Act, 1872 and the Parsi Marriage and Divorce Act, 1935. Other marriage Acts, which exist, include; the Special Marriage Act, 1954 (for spouses of differing religions) and the Foreign Marriage Act, 1959 (for marriage outside India). The Child Marriage Restraint Act, 1929 as amended in 1978 to prevent the solemnization of child marriages also applies to the disabled. A Disabled person cannot act as a guardian of a minor under the Guardian and Wards Act, 1890 if the disability is of such a degree that one cannot act as a guardian of the minor. The Hindu Minority and Guardianship Act, 1956, as also under the Muslim Law, take a similar position. IV. National Building Code of India 1983 with proposed Amendments : The Ministry of Urban Development and Poverty Alleviation has issued a public notice proposing amendments to the Unified Building Byelaws, 1983, pertaining to the National Capital Territory of Delhi. These steps has been taken with a view to providing a barrier-free environment in public buildings for persons with disability and are applicable to all buildings, recreational areas and facilities used by the public. Domestic residences are exempted in this notification. The notice seeks to identify the disabilities which include impairments that confine individuals to wheelchairs and "impairments that cause individuals to walk with difficulty or insecurity'' and "individuals using braces or crutches, amputees, arthritics, spastics and those with pulmonary and cardiac ills''. It also takes into account hearing and sight disabilities. Main features are: "Every building should have at least one access to main entrance/exit to the disabled which shall be indicated by proper signage. This entrance shall be approached through a proper ramp together with stepped entry' The access path from the plot entry and surface parking to building entrance will have even surface without any step. Slope, if any shall not have gradient greater than 5 percent. Selection of floor material shall be made suitably to attract or to guide visually impaired persons. For parking of vehicles of disabled persons, surface parking for two equivalent car spaces shall be provided near the entrance for the physically challenged persons with maximum travel distance of three metres from building entrance. The information stating that the space is reserved for wheelchair users shall be conspicuously displayed. Guiding floor materials shall be provided or a device, which guides visually impaired persons with audible signals, or other devices, which serves the same purpose, shall be provided, the notice adds. It stipulates that the buildings will have to provide specified facilities such as approach to plinth level, corridor connecting the entrance/exit for the handicapped, stair-ways, lift, toilet and drinking water. While braille signage shall be provided at the above-specified facilities, the notice also calls for provision of ramps with non-slip material at the entry to the building. Guiding floor materials or devices that emit sound shall be provided to guide the visually impaired persons in the corridor connecting the entrance and exit for the handicapped. Stairways with open riser and provision of nosing are not permitted in such buildings. Wherever lift is required as per bye-laws, provision of at least one lift shall be made for the wheel-chair user with specified cage dimensions. The braille signage will be posted outside the lifts. It also lays down that "one special WC in a set of toilet shall be provided for the use of handicapped with essential provision of wash bin near the entrance''. An alternative to immediate evacuation of a building via staircases and/or lifts is the movement of persons with disability to safety areas within a building. If possible, they could remain there until fire is controlled or extinguished or until rescued by fire fighters. It is useful to have the provision of a refugee area, usually at the fire-protected stair- landing on each floor that can safely hold one or two wheel chairs. V. The Mental Act, 1987:Under this Act mentally ill persons are entitled to the following rights: 1.A right to be admitted, treated and cared in a psychiatric hospital or psychiatric nursing home or convalescent home established or maintained by the Government or any other person for the treatment and care of mentally ill persons (other than the general hospitals or nursing homes of the Government). 2.Even mentally ill prisoners and minors have a right of treatment in psychiatric hospitals or psychiatric nursing homes of the Government. 3.Minors under the age of 16 years, persons addicted to alcohol or other drugs which lead to behavioral changes, and those convicted of any offence are entitled to admission, treatment and care in separate psychiatric hospitals or nursing homes established or maintained by the Government. 4.Mentally ill persons have the right to get regulated, directed and co-coordinated mental health services from the Government. The Central Authority and the State Authorities set up under the Act have the responsibility of such regulation and issue of licenses for establishing and maintaining psychiatric hospitals and nursing homes. 5.Treatment at Government hospitals and nursing homes mentioned above can be obtained either as in patient or on an outpatients basis. 6.Mentally ill persons can seek voluntary admission in such hospitals or nursing homes and minors can seek admission through their guardians. The relatives of the mentally ill person on behalf of the latter can seek for admission. Applications can also be made to the local magistrate for grants of such (reception) orders. 7.The police have an obligation to take into protective custody a wandering or neglected mentally ill person, and inform his relative, and also have to produce such a person before the local magistrate for issue of reception orders. 8.Mentally ill persons have the right to be discharged when cured and entitled to leave the mental health facility in accordance with the provisions in the Act. 9.Where mentally ill persons own properties including land, which they cannot themselves, manage, the district court upon application has to protect and secure the management of such properties by entrusting the same to a Court of Wards, by appointing guardians of such mentally ill persons or appointment of managers of such property. 10.The costs of maintenance of mentally ill persons detained as in-patient in any government psychiatric hospital or nursing home shall be borne by the state government concerned unless such costs have been agreed to be borne by the relative or other person on behalf of the mentally ill person and no provision for such maintenance has been made by order of the District Court. Such costs can also be borne out of the estate of the mentally ill person. 11.Mentally ill persons undergoing treatment shall not be subjected to any indignity (whether physical or mental) or cruelty. Mentally ill persons cannot be used without their own valid consent for purposes of research, though they could receive their diagnosis and treatment. 12.Mentally ill persons who are entitled to any pay, pension, gratuity or any other form of allowance from the government (such as government servants who become mentally ill during their tenure) can not be denied of such payments. The person who is in-charge of such mentally person or his dependants will receive such payments after the magistrate has certified the same. 13.A mentally ill person shall be entitled to the services of a legal practitioner by order of the magistrate or district court if he has no means to engage a legal practitioner or his circumstances so warrant in respect of proceedings under the Act. VI. The Persons With Disabilities (PWD) Equal Opportunities, Protection of Rights and full Participation Act, 1995: The Persons with Disabilities (Equal Opportunities, Protection of Rights and Full Participation) Act, 1995 had come into enforcement on February 7, 1996. It is a significant step, which ensures equal opportunities for the people with disabilities and their full participation in the nation building. The Act provides for both the preventive and promotional aspects of rehabilitation like education, employment and vocational training, reservation, research and manpower development, creation of barrier-free environment, rehabilitation of persons with disability, unemployment allowance for the disabled, special insurance scheme for the disabled employees and establishment of homes for persons with severe disability etc. Main Provisions of the Act: 1) Prevention 2)Education 3)Employment 4) 5) Research 6) 7)Social 8) Grievance and Redressal and Early Detection and Affirmative Manpower of Disabilities Non-Discrimination Development Action Security Prevention and early detection of disabilities -Surveys, investigations and research shall be conducted to ascertain the cause of occurrence of disabilities. -Various measures shall be taken to prevent disabilities. Staff at the Primary Health Centre shall be trained to assist in this work. -All the Children shall be screened once in a year for identifying at-risk cases. -Awareness campaigns shall be launched and sponsored to disseminate information. -Measures shall be taken for pre-natal, peri natal, and post-natal care of the mother and child. Education -Every Child with disability shall have the rights to free education till the age of 18 years in integrated schools or special schools. -Appropriate transportation, removal of architectural barriers and restructuring of modifications in the examination system shall be ensured for the benefit of children with disabilities. -Children with disabilities shall have the right to free books, scholarships, uniform and other learning material. -Special Schools for children with disabilities shall be equipped with vocational training facilities. -Non-formal education shall be promoted for children with disabilities. -Teachers Training Institutions shall be established to develop requisite manpower. -Parents may move to an appropriate forum for the redressal of grievances regarding the placement of their children with disabilities. Employment -3% of vacancies in government employment shall be reserved for people with disabilities, 1% each for the persons suffering from: Blindness or Low Vision Hearing Impairment Locomotor Disabilities & Cerebral Palsy Suitable The The Scheme training and relaxation shall welfare of be of persons upper formulated with age for disabilities limit Regulating the employment Health and Safety measures, and creation of a non-handicapping, environment in places where persons with disabilities are employed. -Government Educational Institutes and other Educational Institutes receiving grant from Government shall reserve at least 3% seats for people with disabilities. -No employee can be sacked or demoted if they become disabled during service, although they can be moved to another post with the same pay and condition. No promotion can be denied because of impairment. Affirmative Action -Aids and Appliances shall be made available to the people with disabilities. -Allotment of land shall be made at concessional rates to the people with disabilities for: House Business Special Recreational Centres Special Schools Research Schools Factories by Entrepreneurs with Disability, Non-Discrimination -Public building, rail compartments, buses, ships and air-crafts will be designed to give easy access to the disabled people. -In all public places and in waiting rooms, the toilets shall be wheel chair accessible. Braille and sound symbols are also to be provided in all elevators (lifts). -All the places of public utility shall be made barrier-free by providing the ramps. Research and Manpower Development -Research in the following Prevention Rehabilitation including Development of Assisstive Devices. areas shall of community be sponsored and based promoted: Disability rehabilitation -Job Identification -On site Modifications of Offices and Factories -Financial assistance shall be made available to the universities, other institutions of higher learning, professional bodies and non-government research -units or institutions, for undertaking research for special education, rehabilitation and manpower development. Social Security -Financial assistance to non-government organizations for the rehabilitation of persons with disabilities. -Insurance coverage for the benefit of the government employees with disabilities. -Unemployment allowance to the people with disabilities who are registered with the special employment exchange for more than a year and could not find any gainful occupation. Grievance Redressal -In case of violation of the rights as prescribed in this act, people with disabilities may move an application to the: -Chief Commissioner for Persons with Disabilities in the Centre, or -Commissioner for Persons with Disabilities in the State. Convergence of Actions from Government Departments For Implementing PWD ACT 1995 In view of the comprehensive nature of the requirements to meet the actions of the PWD Act 1995, convergence of affirmative actions is required from several central and state government ministries and departments. The ministries directly involved in providing support are: Department of Education Department of Personnel and Training Ministry of Finance (Banking Division) Ministry of Science and Technology Ministry of Social Justice and Empowerment Ministry of Rural areas and Employment Ministry of Railways Ministry of Health Department of Public Enterprise Department of Women and Child Department Director General of Labour and Employment Ministry of Urban Affairs and Employment. VII. The Rehabilitation Council of India Act, (RCI Act 1992) The Rehabilitation Council of India (RCI) was set up as a registered society in 1986. However, it was soon found that a Society could not ensure proper standardization and acceptance of the standards by other Organizations. The Parliament enacted Rehabilitation Council of India Act in 1992. The Rehabilitation Council of India becomes Statutory Body on 22nd June 1993. Major objectives of RCI is: 1) To regulate the training policies and programmes in the field of rehabilitation of persons with disabilities 2) To bring about standardization of training courses for professionals dealing with persons with disabilities 3) To prescribe minimum standards of education and training of various categories of professionals/ personnel dealing with people with disabilities 4) To regulate these standards in all training institutions uniformly throughout the country 5) To recognize institutions/ organizations/ universities running master's degree/ bachelor's degree/ P.G. Diploma/ Diploma/ Certificate courses in the field of rehabilitation of persons with disabilities 6) To recognize degree/diploma/certificate awarded by foreign universities/ institutions on reciprocal basis 7) To promote research in Rehabilitation and Special Education 8) To maintain Central Rehabilitation Register for registration of professionals/ personnel 9) To collect information on a regular basis on education and training in the field of rehabilitation of people with disabilities from institutions in India and abroad 10) To encourage continuing education in the field of rehabilitation and special education by way of collaboration with organizations working in the field of disability. 11) To recognize Vocational Rehabilitation Centres as manpower development centres 12) To register vocational instructors and other personnel working in the Vocational Rehabilitation Centres 13) To recognize the national institutes and apex institutions on disability as manpower development centres 14) To register personnel working in national institutes and apex institutions on disability under the Ministry of Social Justice & Empowerment The RCI Act was amended by the Parliament in 2000 to work it more broad based. It prescribes that any one delivering services to people with disability, who does not possess qualifications recognized by RCI, could be prosecuted. Thus the Council has the twin responsibility of standardizing and regulating the training of personnel and professional in the field of Rehabilitation and Special Education. This Act provides guarantees so as to ensure the good quality of services rendered by various rehabilitation personnel. Following is the list of such guarantees: To promote research in rehabilitation and special education. To register vocational instructors and other personnel working in the vocational rehabilitation centers and recognize vocational rehabilitation centers as manpower development centers. To register working personnel in national institutes and apex institutions on disability under the Ministry of Social Justice & Empowerment and recognize the national institutes as apex institutions on disability as manpower development centers. To have uniformity in the definitions of disabilities with the Persons with Disabilities (Equal Opportunities, Protection of Rights and Full Participation) Act, 1995. VIII. The National Trust for Welfare of Person with Autism, Cerebral Palsy, Mental Retardation and Multiple Disabilities Act, 1999 Main objectives of the National Trust: 1) To enable and empower persons with autism, cerebral palsy, mental retardation and multiple disabilities to live as independently and as close as possible to the community to which they belong. 2) Provide support to the persons with disability so that they may be able to live with their families. 3) Extend support to the registered organizations so as to enable them provide need- based services during the period of crisis. 4) Deal with the problems of persons with such kind of disability that lack a family support. 5) Promote measures for the care and protection of such disabled persons in the event of a death of their parent or guardian. 6) Evolve procedures for the appointment of guardians and trustees for persons with disability requiring such protection. 7) Facilitate the realization of equal opportunities, protection of rights and fullest social participation by such disabled persons. Thrust Areas: Campaign for effecting positive attitudinal change Programmes which foster inclusion and independence by: 1)Creating barrier-free environments 2)Developing skills 3)Promoting self-help groups 4) Training and support of care givers and community members 5) Formation of local level committees to grant approval for guardianship 6) Development of sustainable models for day care, home based, respite and residential care 7) Advocacy for the rights of persons with four disabilities 8) Research in the four areas of disabilities 9) Programmers for persons with severe disabilities and women with disabilities. Programmes: 1) Registration of associations (of Parents and Non2) Formation of local 3) Appointment of 4) Support for a range of services including 5) Home visiting/ care 6) Development of awareness and 7) Community Participation Programme for Reach and Relief, etc. Part-2 Government Organisations) level committees the guardians residential accommodation. givers programme training material Disabled Persons Magnitude and Characteristics Introduction: The history of collecting census in India dates back to 1871, when first census was conducted under the British rule. The questionnaire of 1872, called the 'House Register' included questions not only on the physically disabled but also the intellectually disabled persons and persons affected by leprosy. However this practice was discontinued after the 1931 census. The comeback of disability census in 1981, after a gap of nearly 50 years, was at an opportune time as the United Nations had declared the year as the 'International Year of the Disabled'. The question in the census of 1981, asked people, if any person in the households were, totally blind, totally crippled and/or totally disabled. Enumerators were not appropriately trained to collect this sensitive information. As was expected, the total numbers of disabled persons recorded at the national level were only 0.16 % of the total enumerated population. Only 1,118,948 disabled persons form rural areas and 149,547 disabled persons from urban areas were recorded in 1981 census, which was contrary to several estimated figures given by different government and NGOs sources. The data of 1981 census for disabled persons created a lot of confusion about the actual magnitude of disabled persons in India . Ministry of Social Welfare requested the National Sample Survey Organization (NSSO) to devote 37 th round in 1981, especially for collecting data on disability, to clear the air of confusion created by the census data. Subsequently because of the inadequacies of data collection for disabled persons in 1981 the census discontinued disability question again in 1991 Census. Instead NSSO round 47 th in 1991 was also devoted to gather information for disabled population from selected sample areas. The decade of 1990-2000 witnessed intense lobbying and pressure mounted from civil society organizations throughout the country for prevention, protection and rehabilitation of disabled persons, as it was considered as a rights issue instead of welfare measure. This pressure culminated into passing of the Prevention of Disability Act (PWD Act- 1995) in the Indian parliament for providing equal opportunities to disabled persons. Intense lobbying and pressure also resulted in inclusion of a question on disability in the Census 2001, to ascertain the magnitude and types of disability in India . Separate questions on disability were included in the census 2001. Emphasis was given to provide appropriate training to the enumerators to record the disabled people correctly in 2001 Census. Subsequently NSSO devoted 58 th round in 2002 for collecting information on disabled persons to supplement the data recorded in 2001 census as well as for helping policy makers to draw comparative picture on disability in continuation to data collected in the NSSO rounds of 1981 and 1991. Unfortunately the census 2001 data for disability section has not been published so far; hence the present report is based on the information provided in the NSSO rounds 37 th , 47 th and 58 th conducted in 1981, 1991 and 2002 respectively. Estimates of the number of disabled persons in India vary a great deal because of non-availability of census information as well as due to varying definitions, sources of data, the methodology used for data collection and the extent of use of scientific instruments in identifying and measuring the degree of disability. The National Sample Survey Organisation (NSSO) conducted three countrywide sample surveys in 1981, 1991 and 2002 for measuring the extent and types of disabled persons in India . (For details of sample coverage refer details of sampling given in the NSSO rounds 37 th , 47 th and 58 th ) Disabled Persons, Magnitude: According to these NSSO surveys, there were 13.67 million disabled persons in 1981 and 16.36 million disabled persons in 1991 (who were having at least one or more of the four types of disabilities viz. - locomotor, visual, hearing and speech). The NSSO survey 58th Round in 2002, covered mental disability in addition to the above stated four disabilities. According to the NSSO 58 th round the magnitude of the one or more than one of the five-disabilities was 18.49 million in 2002. (Refer Table No. II. 1.1) Table Disabled Population in India No. II.1.1 Magnitude (in Million) 1981-2002 Year Male 1981 1991 2002 Female Rural Both Male Female 5.21 5.77 12.65 14.08 2.07 2.58 7.44 8.31 Urban Both Male 1.42 1.82 3.50 4.40 Rural + Urban Female Both 9.51 10.89 6.63 7.59 13.67 16.36 18.49 Source: NSSO Rounds 37 th , 47 th and 58 th in 1981,1991 and 2002. The NSSO 47 th round in 1991 registered 16.36 million disabled persons out of which 9.51 million disabled persons were males and 6.63 million disabled persons were females. The males, females proportion constituted 59 and 41 percent of the disabled persons respectively. The NSSO 58 th round in 2002 recorded 18.49 million disabled persons out of which 10.89 million were males and 7.59 million were females, again constituting 59% and 41% males and females respectively. (Refer Table No.II.1.1) Disabled Person, Gender Distribution: The gender proportion of disabled persons was 10.89 million males and 7.59 million females in 2002. About 58% of the disabled persons were males and 42% were females. The gender proportion of disabled population was similar in 1991 and 2002 in case of both the rural and the urban areas for 1991 and 2002. (Refer Table No.II.1.2) Table No. II.1.2 Disabled Population in India Gender Distribution (Percentage) 1991-2002 Year 1991 2002 Sex Male Rural 58.81 Urban 59.14 Rural + Urban 58.12 Female 41.18 40.57 41.88 Both Male 100 59.01 100 58.63 100 58.89 Female 40.99 41.37 41.11 Both 100 100 100 Source: NSSO Rounds 47 th and 58 th in 1991 and 2002. Disabled Persons, Rural / Urban Distribution: A significant proportion of disabled persons (77%) were dwelling in the rural areas, while the rest 23% were residing in the urban areas. Gender distribution of disabled population did not show any significant variation among the rural and the urban areas both for 1991 and 2002. (Refer Table No.II.1.3) Table No. II.1.3 Disabled Population in India Rural/ Urban Distribution (Percentage) 1991-2002 Year 1991 2002 Sex Rural Male 78.23 Female 78.58 Persons 77.32 Urban 21.77 21.42 22.68 Both Rural 100 76.73 100 76.02 100 76.14 Urban 23.27 23.98 23.86 Both 100 100 100 Source: NSSO Rounds 47 th and 58 th in 1991 and 2002. Disabled Persons, Prevalence Rate: The Prevalence rates (number of disabled persons per 100,000 persons) recorded for disabled persons was 1886 and 1775 respectively in 1991 and 2002, depicting a sharp decline from 1991 to 2002. The prevalence rates have recorded a significant decline for both gender groups in case of both rural and urban areas during 1991-2002. (Refer Table No.II.1.4) Table No. II.1.4 Disabled Population in India Prevalence Rate (per 100,000 persons) 1991-2002 YEAR M 2002 1991 F 2118 2277 RURAL M+F 1556 1694 M 1846 1995 F 1670 1774 URBAN M+F 1331 1361 M 1449 1579 F 2000 2144 BOTH R+U M+F 1493 1775 1609 1886 Source: NSSO Rounds 47 th ,1991, and 58 th Round, 2002. Disabled Persons, Prevalence Rates- Age Groups: The disability prevalence rates among different age groups have indicated both positive and negative aspects. While the prevalence rates have shown declining trends both for rural and urban areas, up to the age group of 14 years in 2002 as compared to 1991, but on the other hand the prevalence rates for the age groups of 15-44 years have registered increase both for rural and urban areas in 2002 as compared to 1991. The causes for the increasing trends in the prevalence rates among the age groups of 15-44 years, needs to be looking into, in order to prevent increasing trends in prevalence rates among the most productive age groups. The prevalence rates have decreased sharply for the age groups of above 60 years, both in rural and urban areas in 2002 as compared to 1991, indicating improved healthcare support for population above 60 years. The analysis of the age wise prevalence rates depicts, healthcare measures and other protective measures through community awareness in the early age groups and older age groups have prevented disabilities. But increasing prevalence rates in the working age groups indicate effects of industrialization and transport sector without appropriate safety measures in place. Mechanization, transport development, haphazard industrialization growth and environmental degradation have made workers exposed to accidents and other disabilities. Hence protective measures need to be devised to safeguard exposer to disabilities in the fast development scenario. The young adults and middle age group population are prone to disabilities due to environmental degradation, pollution and industrialization processes accentuated by haphazard development without taking appropriate measures of preventing ecological imbalances and providing safety measures. Development of transport sector without following appropriate traffic rules, regulations and other qualitative measures have enhanced accidental disabilities. Immediate medical care for the accidental cases is non-existent in majority of the rural areas, leading to permanent disabilities. Unfortunately social model of barrier free community awareness is not in place, hence these disabled people are without any community support and they remain segregated / excluded from the community activities. (Refer Table No. II.1.5 and Figure No. II.1.1) Table No.II.1. 5 Disabled Population in India Prevalence Rate- Age Groups (Per 100,000 persons) 1991-2002 Age Group Rural 0-4 5-9 10-14 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60+ 5 & Above 2002 Urban 523 1167 1549 1748 1627 1487 1448 1444 1594 1907 2283 3025 6401 1846 1991 Rural 487 1015 1317 1337 1242 1000 1054 1138 1309 1476 1855 2571 5511 1499 Urban 533 1578 1605 1480 1189 1105 1258 1300 1708 2066 2885 3521 9184 2217 Source: NSSO Rounds 47 th , 1991, and 58 th Round, 2002. Disabled Persons,Prevalence Rates- Inter-state Variations: 564 1430 1510 1274 1030 917 865 891 1149 1448 2043 2766 7623 1702 Inter-state variations of the prevalence rates for disabled persons have been depicted through the maps for both gender groups separately among the rural and the urban areas for 1991 and 2002; in order to examine the change registered (Refer Table No. II.1.6 and II.1.7 and Map No. II.1.1 and II.1.2.). The prevalence rate data for 1991 was not available for some of the Table No. II.1.6 India Disabled persons Prevalence Rate (Per 100,000 persons) Male STATES 1991 Andaman & N.Isl Andhra Pradesh Arunachal Pradesh Assam Bihar Chandigarh Chhatisgarh D & N Haveli Daman & Diu Delhi Goa Gujarat H.P. Haryana J&K Jharkhand Karnataka Kerala Lakshadeep Madhya Pradesh Maharastra Manipur Meghalaya Mizoram Nagaland Orissa Panichery Punjab Rajasthan Sikkim Tamil Nadu Tripura Uttar Pradesh Uttranchal W. Bengal All India RURAL 2002 2354 947 1125 1557 2157 1665 1891 1636 1794 1927 2166 2384 1355 2201 1441 1484 2277 URBAN 1991 2766 1980 1861 1062 2098 865 2012 990 649 823 2326 2169 3326 2256 2120 1614 1977 2451 2768 1969 2375 1092 1871 855 895 2671 1817 2576 1826 1860 2188 748 2319 2200 2006 2118 2002 1712 948 1071 1566 995 1105 1307 1587 1113 1408 2077 1558 1168 1669 1210 1283 1774 1290 1524 109 1189 1725 577 1973 798 1500 642 1454 1822 1632 1537 1401 1352 1245 2552 1454 1749 1594 1090 1117 814 602 1971 2310 1584 1596 654 1967 1176 1821 1155 2094 1670 Source: NSSO reports round No. 47 th and 58 th , 1991 and 2002. Table No. II.1.7 India Disabled persons Prevalence Rate (Per 100,000 persons) FEMALES STATES 1991 Andaman & N.Isl Andhra Pradesh Arunachal Pradesh Assam Bihar Chandigarh Chhatisgarh D & N Haveli Daman & Diu Delhi Goa Gujarat H.P. Haryana J&K Jharkhand Karnataka Kerala Lakshadeep Madhya Pradesh Maharastra Manipur Meghalaya Mizoram Nagaland Orissa Panichery Punjab Rajasthan Sikkim Tamil Nadu Tripura Uttar Pradesh Uttranchal W. Bengal All India RURAL 2002 2354 947 1125 1557 2157 1665 1891 1636 1794 1927 2166 2384 1355 2201 1441 1484 1694 URBAN 1991 1126 1827 1471 894 1218 703 1582 712 1370 451 1039 1556 2135 1505 1173 938 1521 2010 1983 1499 1677 849 1418 780 944 2418 1792 1813 1202 1565 1864 686 1574 1884 1355 1556 Source: NSSO reports round No. 47 th and 58 th , 1991 and 2002. 2002 1712 948 1071 1566 995 1105 1307 1587 1113 1408 2077 1558 1168 1669 1210 1283 1361 604 1302 27 970 1169 549 1743 610 1229 368 1650 1325 1025 1159 1100 726 973 2082 2592 1220 1398 850 677 569 812 1663 2561 1363 1023 518 1558 1061 1320 665 1740 1311 Union territories. Some states were bifurcated into two states after 1991; hence data for those states was not separately available in 1991 although the data was aggregated with their native states in 1991. The prevalence rate for males depict significant decline in 2002 among majority of states as compared to 1991. However the decline was more pronounced for urban areas as compared to the rural areas. In case of rural areas prevalence rates for males were high for Orissa, Himachal Pradesh, Haryana, while the rates were lowest for the eastern states, Jharkhand, Andhra Pradesh, Karnataka, Madhya Pradesh and Rajasthan. Other states recorded medium level of prevalence rates. In the case of urban areas, the prevalence rates for males were low and uniformly distributed among the Union territories and states except for Kerala and West Bengal , which recorded a high prevalence rates. (Refer Table No. II.1.6 and Map No. II.1.1). The prevalence rates for women have also depicted declining trends in 2002 as compared to 1991 for majority of states in India . However in the case of rural areas the coastal states of Orissa, Kerala, Tamil Nadu and Andhra Pradesh and mountain states of Himachal Pradesh and Uttranchal recorded higher prevalence rates in 2002 compared to other states. Least disability prevalence rates among rural areas were recorded in Bihar , West Bengal , all Eastern states, Madhya Pradesh, Rajasthan and Jammu and Kashmir in 2002. In the case of urban areas disability prevalence rates for women were comparatively higher for Kerala, Tamil Nadu, Orissa, Chattisgarh and West Bengal . All other states and Union territories recorded lower disability prevalence rates among women. (Refer Table No. II.1.7 and Map No. II.1.2) Disabled Persons, Incidence Rates: The disability incidence rates (The number of persons whose onset of disability by birth or after birth has been during the specified period of 365 days preceding the data of the survey collected by the NSSO enumerators, per 100,000 persons) were 90, and 69 respectively in 1991 and 2002, according to the (NSSO rounds 47 th and 58 th in 1991 and 2002). Incidence rates have also decreased for both gender groups in rural and urban areas during 1991- 2002. The incidence rates of disabled persons have declined from 90 to 69 in the rural areas and from 83 to 67 in the urban areas during 1991-2002. Thereby depicting a decline in the overall incidence rate especially among rural areas. Declining incidence rates depict significant healthcare measures are in place especially among infants and children for control of polio and other communicable diseases which were responsible for disabilities in later stages. Similarly community awareness has helped in achieving better immunization coverage, healthcare and other preventive measures for preventing disability among children and old people. (Refer Table No. II.1. 8) Table No. II.1.8 Disabled Population in India Incidence Rate (per 100,000 persons) 1991-2002 YEAR M 2002 1991 F 77 99 RURAL M+F 61 81 M 69 90 F 75 90 URBAN M+F 58 75 Source: NSSO Rounds 47 th 1991, and 58 th 2002. Disabled Person, Incidence Rates- Age Groups: M 67 83 F 76 98 BOTH R+U M+F 60 69 79 90 Significantly the incidence rates among 0-4 and 5-9 age groups has registered a sharp decline both for rural and urban areas, signifying improvement in child care, especially improved immunization coverage for polio eradication - which was the major cause of disability in lower age groups. Polio eradication is a major positive step for preventing disabilities in the early ages. Similarly incidence rates for population above 60 years has also declined in 2002 as compared to 1991, which is a positive sign, indicating measures being in place like; healthcare and old age care for preventing disabilities. But the incidence rate among the age groups of 15-29 years has registered increase in 2002 as compared to 1991, which requires further investigation to identify the causes for such incidence in depth. Perhaps accidents both at work place and while commuting have risen, due to rapid industrialization and urbanization without proper safety measures against accidents. Incidence rates for urban areas for 15-29 years have risen at a faster rate compared to the rural areas for the similar age group. (Refer Table No. II.1.9 and Figure No. II.1.2). Disabled Persons, Incidence Rates- Inter state Variations: The incidence rate for males depict significant decline in 2002 for both rural and urban areas, among majority of states as compared to 1991. In case of rural areas incidence rates for males were comparatively higher for Andhra Pradesh, Goa and Himachal Pradesh while the rates were lowest for all other states. In the case of urban areas, least incidence rates were recorded in Karnataka, Uttranchal, Himachal Pradesh and majority of the Eastern states. However Kerala Jharkhand and Andhra Pradesh registered comparatively higher incidence rates among males in urban as compared to other states. The incidence rates for disabled women also recorded declining trends in 2002 as compared to 1991, but the decline was more in case of urban areas among the states as compared to the rural areas. Andhra Pradesh recorded higher women disability incidence rate among the rural areas. While on the other hand Madhya Pradesh rural areas in particular recorded significant decline in the incidence rates for women in 2002 as compared to 1991. MP, Bihar , Jharkhand and majority of Eastern states recorded least disability incidence rates for rural areas in 2002. In the case of urban areas disability incidence rates for women were found a declining trend in Orrisa, Karnataka, Rajasthan, Bihar and Jharkhand in 2002 as compared to 1991. Chattisgarh state recorded higher incidence rate among women for urban areas. Kerala, Tamil Nadu, Andhra Pradesh, Maharastra, Madhya Pradesh, Gujarat , Uttar Pradesh, Haryana, Punjab , Uttranchal and West Bengal recorded medium level incidence rates in urban areas. (Refer Table No. II.1. 10 and II.1.11 and Map No. II.1.3 and II.1.4) Table No. II.1.9 Disabled Population in India Incidence Rate Age Groups (per 100,000 persons) 1991-2002 Age Group Rural 0-4 5-9 10-14 15-19 20-24 25-29 30-34 35-39 2002 Urban 32 34 38 40 36 33 28 42 1991 Rural 31 28 34 31 19 34 23 45 Urban 95 50 30 30 26 28 36 29 111 27 47 21 17 22 19 32 40-44 45-49 50-54 55-59 60+ 5 & Above All persons 36 71 109 204 363 74 69 61 61 110 196 395 70 67 74 95 124 227 527 90 90 Source: NSSO Rounds 47 th , 1991, and 58 th Round, 2002. Table No. I.1.10 India Disabled persons Incidence Rate (Per 100,000) MALES STATES 1991 Andaman & N.Isl Andhra Pradesh Arunachal Pradesh Assam Bihar Chandigarh Chhatisgarh D & N Haveli Daman & Diu Delhi Goa Gujarat H.P. Haryana J&K Jharkhand Karnataka Kerala Lakshadeep Madhya Pradesh Maharastra Manipur Mizoram Nagaland Orissa Panichery Punjab Rajasthan Sikkim Tamil Nadu Tripura RURAL 2002 128 39 71 74 99 128 97 101 115 124 100 186 57 182 URBAN 1991 0 130 32 2002 12 56 0 85 13 10 22 151 68 131 94 71 17 50 97 121 66 95 62 0 3 68 66 95 73 39 75 9 31 98 100 96 76 64 56 123 98 106 108 84 72 138 44 111 0 23 53 0 145 39 107 13 156 85 26 76 73 52 22 100 41 67 99 73 36 24 57 68 74 84 21 71 44 40 56 155 232 620 79 83 Uttar Pradesh Uttranchal W. Bengal All India 84 86 49 76 77 71 99 71 49 90 61 49 94 75 Source: NSSO Rounds 47 th , 1991, and 58 th Round, 2002. Table No. I.1.11 India Disabled persons Incidence Rate (Per 100,000) FEMALES STATES 1991 Andaman & N.Isl Andhra Pradesh Arunachal Pradesh Assam Bihar Chandigarh Chhatisgarh D & N Haveli Daman & Diu Delhi Goa Gujarat H.P. Haryana J&K Jharkhand Karnataka Kerala Lakshadeep Madhya Pradesh Maharastra Manipur Meghalaya Mizoram Nagaland Orissa Panichery Punjab Rajasthan Sikkim Tamil Nadu Tripura Uttar Pradesh Uttranchal RURAL 2002 137 19 43 49 42 61 90 85 128 90 88 120 60 160 49 URBAN 1991 33 103 52 14 34 50 55 0 96 0 0 77 80 72 54 18 55 97 57 36 75 25 3 42 0 56 68 73 51 17 69 16 63 95 2002 89 63 54 54 41 50 47 48 74 89 178 62 54 150 53 26 64 0 0 30 0 118 42 70 19 0 77 0 80 30 43 25 89 82 57 54 18 22 9 0 43 23 74 34 0 73 9 63 56 W. Bengal All India 57 81 63 61 45 75 74 58 Source: NSSO Rounds 47 th , 1991, and 58 th Round, 2002. Disabled Persons, Onset of Disability Since Birth: Nearly 1/3rd of the disabled persons have acquired disability since their birth depicting impact of heredity, defective gene mutation, congenial defects, inappropriate services at the time of delivery and low level of nutrition and healthcare provided to the pregnant mothers during their pregnancy period. (Refer Table No.II.1.12). Both rural and urban areas have reported around 33% disability cases since birth. A number of cases of inappropriate methods adopted at the time of delivery were also reported through several sample surveys as one of the causes of disability since birth. Hence measures for appropriate immunization coverage and nutritional food for the pregnant mothers needs to be given top priority to reduce disability rates at the time of birth. Table No. II.1.12 Disabled Population in India Onset of Disability Since Birth (per 1000 disabled persons) 1991-2002 YEAR M 2002 F 335 RURAL M+F 315 M 327 F 303 URBAN M+F 298 M 301 F 328 BOTH R+U M+F 311 321 Source: NSSO Rounds 58th, 2002. Disabled Household, Number of Disabled Persons: The number of disabled persons in those household having disabled persons indicate that 92% of these household have one disabled person, while 7% households have two disabled persons and the rest 1% households have two or more than two disabled persons, according to NSSO, 58th round in 2002. No significant variations were registered in the proportion of households having number of disabled persons in the rural and urban areas during 1991 and 2002. However significantly 7-8% households have more than one disabled person in their homes both in rural and urban areas. Thus these households require immediate attention of the government and civil societies to mitigate their hardships as currently government social security schemes for disabled are more or less absent. In many cases these disabled are left without any support from families, society and government. Identification of families with more than one-disabled persons needs to be taken up for support on priority basis. These families should be provided with some source of income in terms of job/ pension or other income benefits depending upon the severity of the disability. (Refer Table no. II.1.13, and Fig. No. I.1.3) The image cannot be display ed. Your computer may not hav e enough memory to open the image, or the image may hav e been corrupted. Restart your computer, and then open the file again. If the red x still appears, y ou may hav e to delete the image and then insert it again. Fig No - II.1.1 The image cannot be display ed. Your computer may not hav e enough memory to open the image, or the image may hav e been corrupted. Restart your computer, and then open the file again. If the red x still appears, y ou may hav e to delete the image and then insert it again. Fig No - II.1.2 The image cannot be display ed. Your computer may not hav e enough memory to open the image, or the image may hav e been corrupted. Restart your computer, and then open the file again. If the red x still appears, y ou may hav e to delete the image and then insert it again. Table No. II.1.13 Disabled Population in India Number of Disabled Persons in households having disabled persons 1991-2002 (Percentages) Number of Disabled Person in Households having Disability Rural One Two More than Two 2002 Urban 92.3 7.0 0.6 1991 Rural 92.3 7.2 0.5 Urban 92.0 7.6 0.4 92.5 7.0 0.5 Source: NSSO Rounds 47th and 58th, 1991 and 2002. Disabled Persons, Severity: Fortunately about 60% disabled persons can function without aid/ appliances, while 13% cannot function even with aid and appliance and another 17% can take self care with the help of aid and appliance. Significantly 10% disabled have neither tried nor have access to aids and appliance and hence cannot take self-care. Significantly the proportion of severely disabled who can not function even with the help of aid/ appliance have come down from 25% in 1991 to 13.1% in 2002 in rural areas and from 20.4% in 1991 to 14% in 2002 in urban areas. This indicates extent of disability has shown declining trends probably due to immediate support and healthcare provided to the disabled. (Refer Table No. II.1.14 and Fig. No. II.1.4). Table No. II.1.14 Disabled Population in India Severity/ Degree of Disability 1991-2002 (Percentages) Degree of Impairment Rural Can not function even with aid Can function only with aid Can function without aid Aid/ appliance not tried/nor available ALL Disabled 2002 1991 Urban 13.1 16.9 60.0 9.9 Rural 14.0 18.4 61.4 5.9 Urban 25.0 15.7 58.5 N.A 20.4 17.4 61.6 N.A 14,085,000 4,406,000 12,652,000 3,502,000 Source: NSSO Rounds 47th and 58th, 1991 and 2002. Disabled Persons, Onset of Disability Since Birth: Nearly 1/3rd of the disabled persons have acquired disability since their birth depicting impact of heredity, defective gene mutation, congenial defects, inappropriate services at the time of delivery and low level of nutrition and healthcare provided to the pregnant mothers during their pregnancy period. (Refer Table No.II.1.12). Both rural and urban areas have reported around 33% disability cases since birth. A number of cases of inappropriate methods adopted at the time of delivery were also reported through several sample surveys as one of the causes of disability since birth. Hence measures for appropriate immunization coverage and nutritional food for the pregnant mothers needs to be given top priority to reduce disability rates at the time of birth. Table No. II.1.12 Disabled Population in India Onset of Disability Since Birth (per 1000 disabled persons) 1991-2002 YEAR M 2002 F 335 RURAL M+F 315 M 327 F 303 URBAN M+F 298 M 301 F 328 BOTH R+U M+F 311 321 Source: NSSO Rounds 58th, 2002. Disabled Household, Number of Disabled Persons: The number of disabled persons in those household having disabled persons indicate that 92% of these household have one disabled person, while 7% households have two disabled persons and the rest 1% households have two or more than two disabled persons, according to NSSO, 58th round in 2002. No significant variations were registered in the proportion of households having number of disabled persons in the rural and urban areas during 1991 and 2002. However significantly 7-8% households have more than one disabled person in their homes both in rural and urban areas. Thus these households require immediate attention of the government and civil societies to mitigate their hardships as currently government social security schemes for disabled are more or less absent. In many cases these disabled are left without any support from families, society and government. Identification of families with more than one-disabled persons needs to be taken up for support on priority basis. These families should be provided with some source of income in terms of job/ pension or other income benefits depending upon the severity of the disability. (Refer Table no. II.1.13, and Fig. No. I.1.3) The link ed image cannot be display ed. The file may hav e been mov ed, renamed, or deleted. Verify that the link points to the correct file and location. Fig No - II.1.1 The link ed image cannot be display ed. The file may hav e been mov ed, renamed, or deleted. Verify that the link points to the correct file and location. Fig No - II.1.2 The link ed image cannot be display ed. The file may hav e been mov ed, renamed, or deleted. Verify that the link points to the correct file and location. Table No. II.1.13 Disabled Population in India Number of Disabled Persons in households having disabled persons 1991-2002 (Percentages) Number of Disabled Person in Households having Disability Rural One Two More than Two 2002 Urban 92.3 7.0 0.6 1991 Rural 92.3 7.2 0.5 Urban 92.0 7.6 0.4 92.5 7.0 0.5 Source: NSSO Rounds 47th and 58th, 1991 and 2002. Disabled Persons, Severity: Fortunately about 60% disabled persons can function without aid/ appliances, while 13% cannot function even with aid and appliance and another 17% can take self care with the help of aid and appliance. Significantly 10% disabled have neither tried nor have access to aids and appliance and hence cannot take self-care. Significantly the proportion of severely disabled who can not function even with the help of aid/ appliance have come down from 25% in 1991 to 13.1% in 2002 in rural areas and from 20.4% in 1991 to 14% in 2002 in urban areas. This indicates extent of disability has shown declining trends probably due to immediate support and healthcare provided to the disabled. (Refer Table No. II.1.14 and Fig. No. II.1.4). Table No. II.1.14 Disabled Population in India Severity/ Degree of Disability 1991-2002 (Percentages) Degree of Impairment Rural Can not function even with aid Can function only with aid Can function without aid Aid/ appliance not tried/nor available ALL Disabled 2002 1991 Urban 13.1 16.9 60.0 9.9 Rural 14.0 18.4 61.4 5.9 Urban 25.0 15.7 58.5 N.A 20.4 17.4 61.6 N.A 14,085,000 4,406,000 12,652,000 3,502,000 Source: NSSO Rounds 47th and 58th, 1991 and 2002. Disabled Persons- Social and Economic Composition and Characteristics: Age Distribution: The pattern of prevalence rate of disabled persons is closely related with different age groups. A significant proportion of the disabled persons (53% in rural areas and 55% in urban areas) were in the active working age groups of 15-59 years. Significantly the proportion of disabled population has increased during 1991-2002 for the age groups of 15-44 years for both rural and urban areas. A significant proportion of disabled populations were in the age group of 5-14 years although the proportion in this age group has declined in 2002 as compared to 1991. Proportion of disabled population above 60 years in 2002 has also decreased as compared to 1991 for both rural and urban areas. Thus effective measures have been initiated to prevent the disability in the early and late ages through improved healthcare system, better immunization coverage and awareness for using aids and appliances to overcome disability in the long run. (Refer Table No.II.1.15 and Figure No. II.1.5) Table No. II.1.15 Disabled Population in India Age Distribution (Percentage) 1991-2002 Age Group Rural Less than 4 5-14 15-44 45-59 60+ ALL 2002 Urban 3.1 18.3 38.2 14.7 25.7 14,085,000 1991 Rural 3.0 16.3 40.3 15.1 25.3 4,406,000 Urban 3.5 19.1 29.8 15.3 32.2 12,652,000 3.9 20.9 33.6 13.4 28.2 3,502,000 Source: NSSO Rounds 47 th and 58 th in 1991 and 2002. Disabled Persons, Social Group Composition: The social composition of disabled persons depicts that a significant proportion of them were scheduled castes (23% in rural areas and 18% in urban areas). About 8.5% and 2.5% disabled persons were scheduled tribes in rural and urban areas respectively. The proportion of disabled persons among different social groups did not register any significant deviation in 2002 as compared to 1991. However the proportion of scheduled caste disabled persons increased slightly in urban areas in 2002 as compared to 1991. This may be explained owing to push migration of scheduled caste persons due to non-availability of earning opportunities from agricultural activities. Thus whole families of scheduled castes move to urban areas from rural areas in search of income avenues. (Refer Table No. II.1.16 and Figure No. II.1.6) Table No. II.1.16 Disabled Population in India Social Composition (Percentage) 1991-2002 Social Group 2002 1991 Rural Scheduled Tribes Scheduled Urban 8.4 23.2 Rural 2.5 18.4 Urban 9.4 22.0 2.4 16.9 Castes Others ALL 68.4 14,085,000 79.1 4,406,000 68.6 12,652,000 80.6 3,502,000 Source: NSSO Rounds 47 th and 58 th in 1991 and 2002. The link ed image cannot be display ed. The file may hav e been mov ed, renamed, or deleted. Verify that the link points to the correct file and location. Fig No - II.1.4 The link ed image cannot be display ed. The file may hav e been mov ed, renamed, or deleted. Verify that the link points to the correct file and location. Fig No - II.1.5 The link ed image cannot be display ed. The file may hav e been mov ed, renamed, or deleted. Verify that the link points to the correct file and location. Fig No - II.1.6 Disabled Persons, Marital Status Composition: The marital status of the disabled persons in 2002 indicates that 43% disabled have never married, while 39% are currently married and a significant 15% are widowed and around 1% are divorced or separated. Insignificant variations were recorded in the marital status of disabled population both in case of the rural and urban areas. However significant decline in the proportion of widowed disabled persons was recorded between 1991-2001 in rural areas, indicating general declining death rates and increasing age for expectation of life in rural areas. This demographic transition has helped in providing security to the disabled spouse from the other spouse. However proportion of disabled persons, who never married has also increased from 38.3% to 43.2% in rural areas between 19912002. Significantly 27.8% and 32.4% disabled persons were never married in the ages above 15 years in rural and urban areas respectively in 2002. This indicates that reluctance of marrying disabled persons is catching up even in rural areas. Thus in the absence of homes and other social security services, disabled persons are left alone without any family support in the later ages. These disabled persons are vulnerable for exploitation from the society forcing them to live in streets without any social and economic security. The policy makers must devise measures to rehabilitate them by developing community homes to provide social security to these vulnerable disabled persons in their older ages. Currently number of homes for rehabilitation purpose is far less than the actual demand of these vulnerable groups (Refer Table No.II.1.17 and Figure No. II.1.7) Table No. II.1.17 Disabled Population in India Marital Status (Percentage) 1991-2002 Social Group Rural Never Married Currently Married Widowed Divorced / Separated 2002 Urban 43.2 39.4 15.6 1.8 1991 Rural 45.5 38.1 15.2 1.3 Urban 38.3 38.7 21.8 1.2 45.3 35.9 17.9 0.8 ALL 14,085,000 4,406,000 12,652,000 3,502,000 Source: NSSO Rounds 47 th and 58 th in 1991 and 2002. Disabled Persons, Current Living Arrangements: Information on the current living arrangement of the disabled persons reveals that about 3% disabled persons were living alone and 6-7% were staying with relations or non-relations. Only 5.5% -disabled people were staying only with spouses and another 32% were staying together with spouses and other. Significantly nearly 38-40%-disabled persons were staying with parents without spouses. Hence these disabled persons are vulnerable to exploitation or are left to themselves at the mercy of community after the death of their parents. This information demonstrates immediate need of rehabilitation homes for the disabled persons with support from government or civil society organizations. Significantly high proportion of disabled persons continues to live with parents, which has lessened burden of support from the government/ community for the time being. But these disabled persons require support in the older age. A distressing trend of neglect from children has been observed in 2002 as compared to 1991. The proportion of disabled persons staying with children has declined during 1991-2002, both for rural and urban areas. The current social and economic system of encouraging single-family norm is perhaps responsible for this. The current status of living arrangement of disabled persons demonstrates, policy makers must provide social security services for the disabled persons as otherwise a significant proportion of them will lead a life of outcaste and their exclusion from the society will be enhanced. The social model of providing barrier free life for these disabled persons requires immediate measures of providing appropriate income avenues through job security, vocational up-gradation or pension scheme depending upon the severity of the disability. Significantly there has been slight decrease in the proportion of disabled persons who were living alone in 2002 as compared to 1991. This trend needs to be further strengthened by creating mass awareness, so that family members and society takes appropriate care to look after the disabled persons. (Refer Table No.II.1.18 and Figure No. II.1. 8) Table No. II.1.18 Disabled Population in India Current Living Status Arrangement (Percentage) 1991-2002 Current Living Status Rural Alone Only with Spouse With Spouse and others Without Spouse with Parents With Children With Relations With Non-relations ALL 2002 1991 Urban 3.1 5.5 32.0 39.9 Rural 3.3 4.4 31.3 38.6 Urban 4.3 5.3 31.6 33.0 5.5 4.1 28.9 37.1 12.4 6.7 0.4 14,085,000 12.4 8.0 1.9 4,406,000 17.4 7.5 0.3 12,652,000 14.7 8.4 0.7 3,502,000 Source: NSSO Rounds 47 th and 58 th in 1991 and 2002. Disabled Persons, Literacy and Education Levels: The current educational system supports exclusion of disabled children from the education system, as accessibility as well as methodology of teaching in the schools in unfavorable for them. Most of the disabled children are unable to reach schools due to unfriendly communication and accessibility approach of the schools. Even the staff available in the schools is not trained to provide appropriate educational training to the disabled children. Thus enabling conditions for promoting inclusive education for disabled children needs specific measures to attract disabled children. The distribution of disabled persons (aged 5 years and above) by level of general education (including illiteracy) was ascertained by the NSSO reports in 1991 and 2002. As expected about 59% disabled persons in rural areas and 40% disabled persons in urban areas were illiterate. However a satisfying note was that illiteracy rate among disabled persons in rural areas has declined from 70.1% to 59% while it has decreased from 46.2% to 40% in urban areas during 1991- 2002. But as compared to the general population trends, the picture is still gloomy and depressing, which requires immediate measures like promoting inclusive education/ and opening of specialized schools for disabled children depending upon the nature and severity of their impairment. Even among disabled literates, significant proportions were educated only up to primary or middle level both in rural and urban areas. Only 7% and 17% disabled persons in rural and urban areas respectively, were educated up to secondary or above secondary levels in 2002. The proportion of disabled persons educated up to secondary or above secondary level was very low in 1991 compared to 2002. This indicates that some positive changes have taken place to improve the secondary and higher education levels for disabled persons during 1991-2002 but it requires further strengthening. Providing vocational training is one of the alternatives for making disabled persons secure, to earn their livelihood. Unfortunately in spite of several measures like opening of vocational rehabilitation centers by the Ministry of Labour through the development of VRCs, yet only 1.5% and 3.6% disabled population in rural and urban areas respectively had received vocational training in 2002. Insignificant increase in the proportion of disabled persons, who had received vocational training were recorded during 1991 2002. In fact the proportion of disabled persons having received vocational training was more or less similar in 1991 and 2002 both for rural and urban areas. The nature of vocational training received also depicts that majority (80% in rural and 75% in urban area) of the vocationally trained disabled persons had received non-engineering, low profile vocational training. Thus majority of them lacked earning capacity through the training. Only 20% and 25% vocational trained disabled persons in rural and urban areas respectively had received engineering training. The educational scenario depicts that majority of disabled persons are not provided equal opportunities for education and even few who are enrolled in schools are not provided equal opportunity for middle, secondary and higher education levels. At the best they are currently educated illiterates, without any capacity development for earning their livelihood. Thus the present education system has provided little incentives for their social and economic development. It is essential to provide enabling environment through easy accessibility for schooling and quality teaching and training in schools by developing appropriate trained staff to meet their educational requirements. These disabled also require appropriate vocational training skills to make them self reliant and productive members of the society. Inspite of the provisions of inclusive education and educational reservation in the PWD Act-1995, the desired results are eluding due to government indifference and communities lack of interest to integrate these disabled with the society. Special attention needs to be made to provide specialized schools for each disability groups, who cannot be included in the normal schooling systems. Specific budget provisions for making easy availability of aids and appliances required for the education of the disabled persons needs to be given priority. Currently few NGOs are working for special educational needs of the disabled through government funds. The allocation of the funds for such NGOs must be increased. Vocational training centers for disabled persons require impetus from government. Proper and appropriate identification of the vocations for disabled persons depending upon the market requirement must be undertaken before imparting vocational training. Even marketing of the produced items by disabled persons should be arranged through government / NGOs initiatives. (Refer Table No. II.1.19 and Figure No. II.1.9) Disabled Persons, Usual Work Activity Status: One of the basic objectives of the PWD Act- 1995 was to provide enabling environment for work and employment for disabled persons to make them self-reliant and a part of productive force. The prevailing educational and vocational training scenario imparted to disabled persons, does not provide encouraging enabling environment for their work both in rural and urban areas. The usual work activity status (Activity status during last 365 days preceding the survey) for the disabled persons recorded by the NSSO survey 58 th round in 2002, depicts that 62% and 89% males and females respectively in rural areas and 63.5% and 90.5% males and females respectively in urban areas were out of labour force. The rest of the disabled males and females in rural and urban areas were either partially unemployed or employed. Thus the nature of usual work activity status picture was not only gloomy and depressing for disabled persons but it was also biased and unfavorable towards female disabled both in rural and urban areas. The gender gap in educational services and vocational training services needs to be corrected and impetus must be given through specific grants, opening of specialized educational institutions for women to encourage educational and vocational training for disabled women. (Refer Table No. II.1.20 and Figure No.II.1. 10). Table No. II.1.19 Disabled Population in India Educational Status (Percentage) 1991-2002 Educational Status 2002 Rural Non-literate Primary Middle Secondary Higher-secondary Graduation and above Not Reported Vocational Training received Urban 59.0 24.4 9.7 3.8 2.1 1.0 0.1 1.5 Rural 40.0 28.8 13.7 7.8 5.1 4.6 0.1 3.6 Urban 70.1 20.3 5.3 2.3 0.8 0.4 0.8 1.2 46.2 29.8 11.0 6.4 2.8 3.1 0.8 3.1 Engineering 20 25 20.2 26.6 Non-Engineering ALL 80 14,085,000 75 4,406,000 79.8 12,652,000 73.4 3,502,000 1991 Source: NSSO Rounds 47 th and 58 th in 1991 and 2002. Table No. II.1.20 Disabled Population in India Usual Activity Status (Percentage) 1991-2002 Usual Activity Status Male Employed Unemployed RURAL Female 36.9 0.8 Male 10.9 0.2 URBAN Female 34.7 8.7 1.8 0.4 Out-of -Labour Force 62.2 Source: NSSO Rounds 58 th in 2002. The link ed image cannot be display ed. The file may hav e been mov ed, renamed, or deleted. Verify that the link points to the correct file and location. Fig No - II.1.7 The link ed image cannot be display ed. The file may hav e been mov ed, renamed, or deleted. Verify that the link points to the correct file and location. Fig No - II.1.8 88.9 63.5 90.9 The link ed image cannot be display ed. The file may hav e been mov ed, renamed, or deleted. Verify that the link points to the correct file and location. Fig No - II.1.9 Disabled Persons, Work Activity Status The work activity status of disabled persons depicts that about 46% of disabled populations both in rural and urban areas were without any work. Significantly the proportion of persons without any work has remained similar both in 1991 and 2002. Thus in spite of the PWD Act 1995, employment scenario has not changed for the disabled persons. Provision of reservation of 3% jobs in all government services has not changed employment scenario for disabled persons since 1991 effectively, probably due to non-implementation of the provisions of the Act as well as very small coverage of employment in government sector. Only 1.8% and 7.3% disabled persons in rural and urban areas respectively were regular employees in 2002. Even the nature of employment was only in low-level profile of jobs with low-income. Although 3% job reservation in all categories (A, B, C, and D groups) were stipulated in the PWD Act-1995, yet very few attempts have been made by the state governments to identify the jobs to be reserved for A and B groups in majority of the states. Although identification of jobs for all four categories has been completed by the central government but little attempts have been made to fill up A and B category post either because of non-availability of appropriate persons or because of improper/ unsatisfactory job identification for A and B groups. A distressing scenario for disabled persons depicts decline in proportion of self-employed in nonagricultural sectors in urban areas and in agricultural sector in rural areas during 1991-2002. Even the proportion of casual employees has declined during 1991-2002 for both rural and urban areas. This could be the impact of Globalization and Structural Adjustment Programmes, where competition has been unfavorable towards these vulnerable groups. A significant proportion of the disabled persons were attending domestic work, which does not generate any significant income opportunities rather majority of them are under paid or at best provided basic food requirements. Thus employment scenario for the disabled population looks gloomy and requires immediate steps from government and private sectors. Provision of incentives through tariff cuts and differential interest rates in the private sector may perhaps ease employment provisions for disabled. Moreover self employment through skill development of disabled persons and provision of interest free loans for starting their entrepreneurship under the guidance and supervision of trained staff is required to provide employment opportunities to majority of disabled persons. (Refer Table No.II.1.21 and Figure No. II.1.11) Table No. II.1.21 Disabled Population in India Work Activity Status (Percentage) 1991-2002 Work Activity Status Rural Self Employed in Agriculture Self Employed in Non-Agriculture Regular Employee Casual Employee Attending Educational Institution Attending Domestic Work Begging No Work ALL 2002 Urban 10.6 5.1 1.8 8.8 13.7 12.8 0.5 46.0 14,085,000 1991 Rural 9.4 2.2 7.3 4.9 16.0 13.5 0.9 44.5 4,406,000 Urban 13.3 4.2 2.0 9.5 11.0 13.5 0.7 45.7 12,652,000 1.9 10.2 7.7 5.5 17.7 15.2 0.8 41.1 3,502,000 Source: NSSO Rounds 47 th and 58 th in 1991 and 2002. Employment Scenario for Disabled Persons: Providing employment opportunities for disabled persons is the top most priority to make them selfreliant. This has been stated in the ILO convention No.159 and Recommendation No.168. Unfortunately very few employment opportunities are provided to the disabled persons due to social, cultural and work potential bias against them. Inspite of the special provision of reservations for disabled persons in all government jobs in the PWD-Act 1995, the results derived from the NSSO survey are depressing, as jobs in government sector are limited. The only opportunity available is self-employment and employment by NGOs and private sector. Unfortunately conducive environment has not been created for employment in private sector in the absence of incentives for private companies. The National Center for Promotion of Employment for Disabled Persons (NCPEDP) in collaboration with the National Association for Blind, Delhi , conducted a survey to examine the efforts made by NGOs to find employment for disabled persons since the enactment of PWD Act- 1995. The survey was conducted among 119 NGOs. Major findings of the survey were as follows: • Only 12.89% disabled people were among the professional staff members of these organizations. Disabled women again formed a dismal 4.47% of the group. The administrative structure of the respondent organizations seems to be dominated by 'non-disabled males'. • About 50% of the disabled people 'placed' by the respondent organizations in the last two years were self-employed. Only 1/4th of the beneficiaries were disabled women. • According to the data, about 90% of the people were earning less than Rs. 2,000 per month. In fact, 47.50% of them earn below Rs. 1,000 per month. • Though 1,628 private sector companies were approached in the last two years for placement by the respondent organizations, only 1, 157 disabled people found jobs in this sector. While 804 public sector companies were approached, only 220 disabled people got jobs in this sector for the last two years. • Only 33.61 % of the respondent organizations register their beneficiaries with employment exchanges. Only 212 disabled people were placed through this channel out of the total job placement of 4,812 disabled persons. • While 5,618 disabled people received vocational training in the last one year, only 4,812 people were placed in the last two years. • Only a handful of organizations provide training in industry related skills to disabled people. Majority of the NGOs provide training in skills like arts and crafts, making stationary items, etc., which limit their options to self-employment. Another study was conducted in 1999 by the NCPEDP to examine employment practices of the corporate sector for disabled persons. About 100 companies (23 Public sector, 63 Private sector and 14 Multinational) were covered for the survey. The results point towards rather a dismal trend in terms of current employment practices in the corporate sector with regard to people with disabilities. Government's apathetic attitude is amply reflected in the miniscule percentage of disabled employees even in public sector organizations who arguably have a larger workforce and for whom it is mandatory to have 3% reservation for disabled persons. Major findings from the study are: • Out of 70 respondent companies, 20 companies do not employ any disabled persons. • Average employment proportion for disabled in these surveyed companies was only 0.40%, In the case of public sector organization the employment proportion was 0.54%, while it was 0.28% for private sector and only 0.05% for multinational companies. Only 10 companies had 1% or above disabled employees. • Percentage of disabled with locomotor disability was found to be highest among the disabled employees, perhaps because of negligible or minimal severity of disability. While proportion of mentally retarded persons was negligible, confirming the stigma/ prejudice that still dictates the employment practice in India . For promoting self-employment, the government has set up National Handicapped Finance Development Corporation (NHFDC). There are channelising agencies of NHFDC in every state and union territory for disbursing loans. Despite these provisions the scenario is quite pathetic. But the results of successful entrepreneurships for disabled person through the help of NHFDC are negligible due to poor guidance, support and marketing opportunities. Civil society organizations and NGOs need to provide sheltered job provision for disabled persons. Disabled Persons, Work Status after Disability: The loss of job or change of job is one of the major psychological and mental problems associated with the onset of disability. Information on whether the disabled person aged 5 years and above was working before the onset of disability was collected by the NSSO survey in 1991 and 2002. About 38.9% and 31.1% disabled persons in rural and urban areas respectively were working before the onset of disability in 2002. Significantly 55.8% and 53.1% of these working people lost their job after the disability in rural and urban areas respectively. Another 13.2% in both rural and urban areas had to change their job due to the onset of the disability. Only 30.9% and 33.6% disabled persons continued with their jobs even after the onset of disability in rural and urban areas respectively. Thus a significant proportion of disabled people faced psychological and mental trauma of either loosing or changing their jobs after the onset of disability. (Refer Table No. II.1.22 and Figure No. II.1. 12) Table No. II.1.22 Disabled Population in India Work Status Before and After Onset of Disability (Percentage) 1991-2002 Work Status Rural Before Disability After Disability 2002 1991 Urban 39.7 46.5 Urban 38.9 55.8 Rural 31.1 53.1 Loss of Work 13.2 13.2 14.5 13.4 Change of Work 30.9 33.6 39.0 44.6 Same Work ALL 1000 1000 1000 1000 Source: NSSO Rounds 47th and 58th in 1991 and 2002. The link ed image cannot be display ed. The file may hav e been mov ed, renamed, or deleted. Verify that the link points to the correct file and location. Fig No - II.1.10 The link ed image cannot be display ed. The file may hav e been mov ed, renamed, or deleted. Verify that the link points to the correct file and location. Fig No - II.1.11 28.7 41.8 The link ed image cannot be display ed. The file may hav e been mov ed, renamed, or deleted. Verify that the link points to the correct file and location. Fig No - II.1.12 Disabled Persons Types Disability: Types and Magnitude: The NSSO data 47 th round presents data for physically and sensory disabled persons in terms of four broad groups namely visual impairment, hearing impairment, speech impairment and locomotor disability. The locomotor disabled constituted 55.33% while the visual; the hearing and the speech disabled persons constituted 24.79%, 20.06% and 12.17% respectively in 1991. The NSSO data 58 th round in 2002 also covered mental disabled persons in addition to the visual, hearing, speech and locomotor disabled persons. Visual disabled were further categorised into the blind and the low vision groups. Similarly mental disabled persons were categorised into mental retardation and mental illness groups. The NSSO 58 th round data depicts 57.50% disabled were having locomotor disability, while 10.88% were blind, 4.39% were having low vision, 16.55% were having hearing impairment, 11.65% had speech disability, 5.37% were mentally retarded and 5.95% were mentally ill. (Refer Table No. II.2.1 and Figure II.2.1) The proportion of disabled persons has shown a significant decline for disability types like visual, hearing and speech. However the magnitude and proportion of the locomotor disability has increased during 1991- 2002. The decline registered in visual disability has been significant during 1991-2002. Its proportion has come down from 24.79% to 15.28% during this period, indicating significant efforts from government and civil society organization to prevent visual impairment through effective preventive healthcare programmes from early age groups. The proportion of hearing impairment has also declined during this period. Its proportion was 16.55% in 2002 as compared to 20.06 % in 1991. Although actual magnitude of speech disabled persons have increased during 1991-2002, yet the proportion of this disability has also declined from 12.17% to 11.65%. However locomotor disability has registered increase. Its share has gone up to 57.50% in 2002 from 55.30% in 1991. The increase in the magnitude and proportion of the locomotor disabled persons during 1991-2002 reflects effects of development processes like mechanization, industrialization, extension of varied transport services etc; In the process of development, this disability types requires appropriate protection and rehabilitation services though network of healthcare services with highly professional and trained staff, extension services for providing equal opportunities for their social and economic welfare and conducive environment, and provision of rehabilitation centres. The magnitude of mental disabled persons, which includes mental retardation and mental illness together constitute 11.33% of the total disabled persons in 2002. 5.37% were mentally retarded with learning and other disabilities, while 5.95% were mentally ill. Table No. II.2.1 Disabled Persons in India Types and Magnitude 1991-2002 (Percentages) Source: NSSO Rounds 47 th in 1991 and 58 th in 2002. Disability Type Numbers 2002 1991 Numbers Visual % to all Disabled 2,013,400 10.88 % to all Disabled N.A N.A Blindness 813,300 4.39 N.A N.A Low Vision 2,826,700 15.28 4,005,000 24.79 Both Hearing Speech Locomotors Mental 3,061,700 2,154,500 10,634,000 994,600 16.55 11.65 57.50 5.37 3,242,000 1,966,000 8,939,000 N.A 20.06 12.17 55.33 N.A Mental Retardation 1,101,000 5.95 N.A N.A Mental Illness 2,095,600 11.33 N.A N.A Both ALL 18,491,000 100.00 16,154,000 100.00 Note: The percentages may not add up to 100 % as multiple disabilities was also recorded for a large number of disabled persons. The link ed image cannot be display ed. The file may hav e been mov ed, renamed, or deleted. Verify that the link points to the correct file and location. Fig No II.2.1 Locomotor Impaired Persons Magnitude, Composition and Characteristics Locomotor Impaired Persons: Persons having loss or lac of normal ability to execute distinctive activities associated with moving self and objects from one place to another are treated as persons having locomotor impairment. Locomotor impairment leads to substantial restriction of the movement of bones, joints or muscles and limbs. Some common conditions giving raise to locomotor disability could be poliomyelitis, cerebral palsy, amputation, injuries of spine, head, soft tissues, fractures, muscular dystrophies etc. Locomotor impairments can be classified as: congenital and acquired. Congenital and developmental examples are cerebral palsy, CTEV, meningocele, meningo myelocele, phocomelias and congenital dislocation of hips. Te acquired locomotor impairments can be grouped into infective and traumatic. The infective may be due to tuberculosis of spine or other joints, chronic osteomyelitis, septic arthritis, acute poliomyelitis, G.B. syndrome, leprosy, encephalitis, AIDS etc. The traumatic impairments are accidents (traffic, domestic, industrial, agricultural, fall from heights, bullet injuries, explosion, violence, sports injuries), natural catastrophes like; earthquakes, floods, etc; Locomotor Impaired Persons, Magnitude: According to the NSSO 58th round (2002), nearly 10.6 million persons constituting 57.50 % of all the disabled population (18. 49 million) in India were locomotor impaired. The reported locomotor impaired persons as per the NSSO survey have shown a significant increase from 8.93 million in 1991 to 10.6 million in 2002. The increase could be probably due to increase in traumatic impairments especially accidents due to increasing vehicular traffic movement, industrial accidents and other occupational hazard accidents. The proportion of locomotor disabled persons to all disabled persons has also marginally increased from 55.3 % in 1991 to 57.50% in 2002. Of the total locomotor-impaired persons nearly 37.61% were females and the rest 62.39% were males in 2002. Gender variation in the locomotor impairment could be explained to the nature of work undertaken by the males, which have more potential of accidents. Hence locomotor impairment caused by occupational and traffic accidents are gender specific, particular more likely for males in India . (Refer Table No. II.3.1 and Figure No. II.3.1) Table No.II.3.1 Locomotor Impaired Persons Magnitude (in 000) 1991-2002 Locomotors Disability Male Rural Urban Both 2002 Female 4998 1635 6633 Both 2983 1016 4000 1991 Male 7982 2651 10634 Female 4396 1370 5766 Both 2411 762 3173 6807 2132 8939 Source: NSSO Survey rounds 47 th and 58 th , 1991 and 2002. Locomotor Impaired Persons Prevalence Rate: The prevalence rate for the locomotor impaired persons (Number of locomotor impaired persons per 100,000 persons) in India has marginally come down from 1074 to 1046 for rural areas and from 962 to 910 for urban areas during 1991 to 2002. The prevalence rates were substantially higher among the males as compared to the females both in rural and urban areas for 1991 and 2002. This indicates that gender specific vulnerability of locomotor impairment for males due to their nature of work activity, which increases their mobility over space and increases their chances of occupational and traffic accidents. (Refer Table No. II.3.2 and Figure No. II.3.2) Table No.II.3.2 Locomotor Impaired Persons Prevalence Rate (per 100,000 persons) 1991-2002 Locomotor Impairment Rural Male 2002 1991 Urban 1274 Rural 1058 Urban 1345 1170 Female 804 730 784 728 Persons 1046 901 1074 962 Source: NSSO Survey Round 47th and 58th in 1991 and 2002. Prevalence rate is number of locomotor disabled persons per 100,000 persons Locomotor Impaired Persons, Inter-state Prevalence Rate: The prevalence rate of locomotor impaired males has depicted marginal declining trends in majority of the states both in case of rural and urban areas during 1991 - 2002. In the case of rural areas significant decline in 2002 as compared to 1991 was recorded for Andhra Pradesh, Karnataka, Chattisgarh and Rajsathan. The prevalence rates among the locomotor impaired males in rural areas were lowest for Jharkhand, West Bengal and all Eastern states. Higher prevalence rates were recorded in Uttar Pradesh, Punjab and Himachal Pradesh. Medium level prevalence rates for males locomotor impaired persons among the rural areas were found in Kerala, Tamil Nadu, Gujarat , Maharastra, Bihar , Uttranchal and Haryana. In the case of urban areas locomotor impaired males recorded declining trends for prevalence rates in Andhra Pradesh, Maharastra and Punjab . The prevalence rate among locomotor impared males was lowest in case of Karnataka, Andhra Pradesh, Orrisa, Jharkhan and all Easter states. Uttar Pradesh and Kerala recoded highest prevalence rates for locomotor impaired males in urban areas. The prevalence rate for locomotor impaired women has increased marginally during 1991 to 2002 in all the states uniformly. Locomotor impaired women recorded lower prevalence rates both for rural and urban areas in all states compared to male counterparts in 2002. Orissa was the only state that recorded higher prevalence rates for locomotor impaired women in 2002 as compared to 1991. All other states except for Punjab had prevalence rates of less than 1000 for locomotor impaired women. In the case of urban areas locomotor impaired women also recoded lower prevalence rates for all states except for Chattisgarh. Gender gap in prevalence rates in favour of males for locomotor impairment is clearly visible for all the states of India . However increasing trends of prevalence rates for locomotor impairment among women as compared to men during 1991- 2002 indicates increasing mobility for women and their work participation in industrial activities. This could be the impact of developmental processes especially increasing industrialization and extended transport mobility. Unfortunately safety measures for transport mobility are not in place. No doubt prevalence rate for locomotor impairment has marginally declined for men during 1991-2002, but at the same time their magnitude has increased. (Refer Table No. III.3.3 and III.3.4 and Map No. II.3.1 and II.3.2) Table No.II.3.3 India Locomotor Impaired Persons Prevalence Rate (Per 100,000) MALES STATES 1991 A.P. Andaman & N. Isl. Arunachal Pradesh Assam Bihar Chandigarh Chhatisgarh D & N Haveli Daman & Diu Delhi Goa Gujraat H.P. Haryana J&K Jharkhand Karnataka Kerala Lakshadeep RURAL 2002 1490 533 1243 1125 1402 1651 1339 1347 URBAN 1991 1164 910 428 449 1381 605 1152 550 308 531 1553 1350 1903 1461 1048 878 1162 1279 1683 2002 1361 552 1168 1229 935 692 1064 1304 949 656 46 553 1132 319 1065 642 1055 472 805 1211 1104 1030 700 931 829 1421 222 M.P. Maharashtra Manipur Meghalaya Mizoram Nagaland Orrisa Pondicherry Punjab Rajasthan Sikkim Tamil Nadu Tripura U.P. Uttaranchal West Bengal All India 1469 1462 1137 2494 1393 1336 1434 1123 1345 1332 1467 506 737 222 263 1213 1058 1814 1177 513 1309 431 1508 1142 999 1274 Source: NSSO Survey rounds 47 th and 58 th , 1991 and 2002. 1245 1254 1160 1375 1100 1207 1247 1046 1170 1123 1006 510 707 270 228 985 1228 1076 1075 295 1172 656 1275 808 1161 1058 The link ed image cannot be display ed. The file may hav e been mov ed, renamed, or deleted. Verify that the link points to the correct file and location. Table No.II.3.4 India Locomotor Impaired Persons Prevalence Rate (Per 100,000) FEMALES STATES 1991 A.P. Andaman & N. Isl. Arunachal Pradesh Assam Bihar Chandigarh Chhatisgarh D & N Haveli Daman & Diu Delhi Goa Gujraat H.P. Haryana J&K Jharkhand Karnataka Kerala Lakshadeep M.P. Maharashtra Manipur Meghalaya Mizoram Nagaland Orrisa Pondicherry Punjab Rajasthan Sikkim Tamil Nadu Tripura U.P. Uttaranchal West Bengal All India RURAL 2002 1028 282 571 822 727 1060 841 750 914 944 804 1378 701 892 690 637 784 URBAN 1991 857 595 378 353 754 620 865 412 812 398 487 870 936 995 494 520 705 888 1158 816 451 346 627 146 328 1173 663 1098 652 335 904 345 861 875 623 804 Source: NSSO Survey rounds 47 th and 58 th , 1991 and 2002. 2002 833 275 649 939 459 501 708 744 679 789 1058 993 712 803 660 600 728 737 420 0 381 678 415 1032 318 787 242 248 932 569 752 390 417 531 994 1351 720 723 316 337 134 147 653 912 936 654 236 771 508 858 393 767 730 Locomotor Impaired Persons, Prevalence Rate (Age Groups): The prevalence rates of locomotor impaired among the children below 4 years of age was 334 and 291 for rural and urban areas respectively. In the case of adolescent and young adults (15 to 24 years of age) the prevalence rates were progressively increasing. It was hovering around 700 -1000 for rural areas and 550-760 for urban areas, depicting higher prevalence rates among the rural areas as compared to urban areas. Immediate availability of appropriate healthcare in urban areas is probably one of the causes of less prevalence rate in spite of urbanization and industrialization and traffic accidents in urban areas. The prevalence rates showed progressively declining trends both for rural and urban areas from the age of 25- 40 years. However the prevalence rate increased for the persons in the ages 40-60 years both for rural and urban areas. Persons above 60 years of age as expected had highest prevalence rates both in rural and urban areas. Substantial decline in the prevalence rate was registered in 2002 from 1991 for the age groups of 515 years and above 50 years. Significantly prevalence rates showed increasing treads during 19912002 for the age groups of 15-50 in case of both rural and urban areas. Nature of job activity without appropriate safety measures in the industries/ work places and traffic movement system and risks undertaken by the adults may be the cause of increase in the prevalence rates in these age groups. Thus age composition is closely associated with the prevalence rates of locomotorimpaired persons. Thereby indicating that preventive measures through precautions and other safety measures in traffic services and at work places are required. Availability of immediate and appropriate healthcare after the accidents can reduce prevalence rates effectively. The overall prevalence rates have remained marginally increased in rural areas, while urban areas have depicted marginal decrease in prevalence rates between 1991-2002. This could be explained by improved healthcare in urban areas. (Refer Table No. II.3.5 and Figure No. II.3.3) Table No.II.3.5 Locomotor Impaired Persons Prevalence Rate Age Groups (per 100,000 persons) 1991-2002 Age Group Rural 0-4 5-9 10-14 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60+ 5 & Above 2002 Urban 334 716 999 1181 1039 895 852 825 912 1143 1258 1668 2796 1046 1991 Rural 291 557 758 875 819 620 669 726 868 941 1224 1683 2888 901 Source: NSSO Survey rounds 47 th and 58 th , 1991 and 2002. Urban 503 1099 1094 990 776 672 799 841 1038 1132 1479 1541 3079 1074 536 1038 1126 883 727 615 564 739 749 886 1063 1436 3146 962 The link ed image cannot be display ed. The file may hav e been mov ed, renamed, or deleted. Verify that the link points to the correct file and location. Fig No II.3.1 The link ed image cannot be display ed. The file may hav e been mov ed, renamed, or deleted. Verify that the link points to the correct file and location. Fig. No. II.3.2 The link ed image cannot be display ed. The file may hav e been mov ed, renamed, or deleted. Verify that the link points to the correct file and location. Fig No II.3.3 Locomotor Impaired Persons, Incidence Rate: The incidence rate (reported cases of locomotor impaired persons per 100,000 persons during the last 365 days preceding the NSSO survey in 2002) for the locomotor impaired persons in India has increased from 42 to 49 for rural areas and 39 to 52 for urban areas during 1991- 2002. This indicates impact of urbanization leading to occupational accidents especially increase in traffic accidents due to increased mobility through vehicular traffic movement. The incidence rate for males was 58 and 60 for rural and urban areas respectively, while it was 40 and 43 for females for rural and urban areas respectively in 2002. Incidence rates have shown decline in 2002 for females both in urban and rural areas, but incidence rates for males have increased marginally for rural areas and substantially for urban areas. (Refer Table No. II.3.6 and Figure No. II.3.4) Table No.II.3.6 Locomotor Impaired Persons Incidence Rate (per 100,000 persons) 1991-2002 Locomotor Impaired Rural Male 2002 1991 Urban 58 Rural 60 Urban 53 54 Female 40 43 64 64 Persons 49 52 42 39 Source: NSSO Survey rounds 47 th and 58 th , 1991 and 2002. Incidence rate is reported disabled persons during the last 365 days from the date of the survey per 100,000 persons. Locomotor Impaired Persons, Incidence Rate- Age Groups : The incidence rates of the locomotor-impaired persons in different age groups indicate that the incidence rates were hovering around 50 up to ages of 50 years in case of both rural and urban areas in 2002. However the incidence rates for the locomotor-impaired persons increased progressively from 55 years onwards and it was hovering around 150-250 for rural areas and 140300 for urban areas for age groups of 55-60 years. Age groups above 60 years registered incidence rate of around 226 and 298 respectively for rural and urban areas. Significantly urban areas reported higher incidence rates for ages 60 and above years. Higher incidence rates for locomotor disability in the older age groups is usually associated with bone fractures and muscle impairments due to sudden falls. A significant decline in the incidence rates for the locomotor impaired persons was recorded from 1991 for all age groups up to 50 years, where as it increased for age groups above 50 years. (Refer Table No.II.3.7 and Figure No. II.3.5) Table No.II.3.7 Locomotor Impaired Persons Incidence Rate Age Groups (per 100,000 persons) 1991-2002 Age Group 2002 1991 Rural 0-4 5-9 10-14 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60+ 5 & Above Urban 25 29 33 35 27 24 19 30 23 49 77 144 226 49 Rural 23 25 27 26 15 27 17 37 48 51 80 141 298 52 Urban 87 35 21 23 21 19 28 23 47 55 65 100 224 53 102 16 37 16 13 17 14 26 28 33 81 145 304 52 Source: NSSO Survey rounds 47 th and 58 th , 1991 and 2002. Age at onset of locomotor Impairment: The NSSO 58 th round estimated the age at onset of disability for the cohort of persons of 60 years and above, who acquired locomotor impairment in course of time. The locomotor impairment is mostly acquired after birth. It seems to start progressing at the age somewhere 20 years and above, as about 90 percent locomotor impaired persons acquired the disability after the age of 20 years in rural and urban areas. About 50-60 percent locomotor impaired persons acquired it after the age of 60 years. Thus old age is major cause of the impairment. Significantly about 3-5 percent persons have acquired locomotor impairment since birth, probable due to heredity or due to inappropriate delivery services at the time of birth of a child leading to cerebral palsy. Prevalence of locomotor disability from birth was also reported for all locomotor-impaired persons enumerated by the NSSO survey 2002. The data depicts that 26.8%, 28.8% and 27.5 % male, female and both male and females respectively were locomotor impaired since birth. Hence locomotor impairment is also a phenomena of heredity, inappropriate delivery service at the time of birth of a child and as well as acquired circumstances probable due to infection and trauma. Majority of the cases of locomotor impairments can be reduced through preventive measures like awareness, appropriate healthcare of pregnant mothers, safe delivery services at the time of birth and observing preventive and safety measures against accidents. Post accidental care is also significant to reduce the severity of impairment effectively. (Refer Table No.II.3.8 and Figure No. II.3.6) Table No.II.3.8 Locomotor Impaired Persons (Distribution of 1000 persons) Age at Onset of Impairment for Cohort persons above 60 years 1991-2002 Age Group Rural Since Birth 0-4 5-9 2002 Urban 59 19 18 1991 Rural 37 24 10 Urban 29 19 21 16 10-19 20-44 45-59 60+ 22 100 288 492 20 73 269 567 34 99 278 541 24 74 280 586 Source: NSSO Survey rounds 47 th and 58 th , 1991 and 2002. Locomotor Impaired Persons, Degree of Impairment: There are several kinds of locomotor impairment, as all locomotor impairments are not of the same severity. The NSSO data of 2002 has identified locomotor impairment in terms of those suffering from paralysis, deformity of limb, loss of limb, dysfunction of joints and limb and others. The data depicts that among the locomotor impaired persons 14.4 % cases had paralysis, while 45.8% cases have deformity of limb, 7.7% cases have loss of limb, 22.2 % cases suffer from dysfunction of joints and limb and 9.8% cases have other locomotor problems in the rural areas. In the case of urban areas 14.6 % cases had paralysis, while 44.2 % cases have deformity of limb, 7.6% cases have loss of limb, 25 % cases suffer from dysfunction of joints and limb and 8.4 % cases have other locomotor problems. The proportion of paralysis cases has decreased both in rural and urban areas, while deformity of limbs cases has increased in 2002 as compared to 1991. This indicates post trauma care has improved but accident rates have increased during 1991-2002. (Refer Table No. II.3.9 and Figure No. II.3.7) Fig No II.3.4 The link ed image cannot be display ed. The file may hav e been mov ed, renamed, or deleted. Verify that the link points to the correct file and location. Fig No II.3.5 The link ed image cannot be display ed. The file may hav e been mov ed, renamed, or deleted. Verify that the link points to the correct file and location. The link ed image cannot be display ed. The file may hav e been mov ed, renamed, or deleted. Verify that the link points to the correct file and location. Fig No II.3.6 Table No.II.3.9 Locomotor Impaired Persons Degree of Impairment (per 000' impaired persons) 1991-2002 Source: NSSO Survey rounds 47 th and 58 th , 1991 and 2002. Degree of Impairment Rural Paralysis Deformity of limb Loss of limb Dysfunction of joints and limb Others 2002 Urban 144 458 77 222 98 Rural 146 442 76 250 84 1991 Urban 207 389 70 230 103 186 416 70 221 105 Locomotor Impairment, Causes : NSSO survey 58 th round in 2002 has identified several causes for locomotor impairment. The common cause for locomotor impairment was found polio, injury other than burns, other illness, stroke, medical and surgical interventions and other unknown reasons etc;. In the case of urban areas injury other than burns and polio were major causes of locomotor impairment. Cerebral Palsy cases were 2.4% in rural areas and 2.3% in urban areas. Significantly the proportion of polio as a cause for locomotor impairment has declined both in rural and urban areas during 1991-2002, due to constant awareness and free supply of polio drop to all children through government and civil society efforts. The proportion of injury due to accidents cases has gone up both in rural and urban areas in 2002 as compared to 1991. (Refer Table. II.3.10 and Figure No.II.3.8) Locomotor Impaired Persons, Education Status: Among the locomotor impaired persons in rural areas 48.6 % were illiterate, 29% were educated only up to primary level, 12.8 % were educated up to middle level, 2.9 % up to secondary level and only 4 % above secondary level. In the case of urban areas 31.8 % were illiterate, 30.1 % were educated up to primary level, 16.2% up to middle level, 9.2 % up to secondary level and 13% above secondary level. Significant increase in the education status of the locomotor impaired persons was registered during 1991-2002 in rural areas, as illiteracy rates have declined from 61.9% to 48.6%. This indicates that the government measures as a result of the PWD-Act 1995 and the awareness generated by the civil society organization has created some impact to expand the coverage of education for disabled persons through inclusive education programmes in rural areas. Table No.II.3.10 Locomotor Impaired Persons Causes of Impairment (per 000' impaired persons) 1991-2002 Cause of Impairment Rural Cerebral palsy Polio Leprosy Stroke Arthritis Cardio respiratory disease Cancer TB Other illness Burns Injury other than burns Medical/ surgical intervention Old age Other reasons Not Known 2002 Urban 24 295 25 66 29 3 3 3 120 20 256 20 35 46 47 Rural 23 270 37 82 35 3 2 3 120 18 271 26 31 41 31 Source: NSSO Survey rounds 47 th and 58 th , 1991 and 2002. 1991 Urban 48 328 30 29 20 24 43 346 19 41 19 5 112 22 211 22 50 54 50 115 15 225 34 39 49 52 The education status of locomotor impaired persons indicates good response to the schemes specially meant for locomotor impaired persons. A significant proportion of locomotor impaired children are enrolled in these schools. However rural/ urban gap still persists in spite of positive measures adopted in the rural areas after the PWD Act-1995. Voluntary sector and private sector needs to be emphasised to provide support inclusive education strategy for mild and moderately affected impaired persons. However severely affected cases require specialised schools. Middle and higher level education for the locomotor disabled is still eluding, hence job reservations for the locomotor disabled are not fully utilized in the absence of qualified and skilled available disabled manpower. (Refer Table II.3.11 and Figure No. II.3. 9). The link ed image cannot be display ed. The file may hav e been mov ed, renamed, or deleted. Verify that the link points to the correct file and location. Fig No II.3.7 The link ed image cannot be display ed. The file may hav e been mov ed, renamed, or deleted. Verify that the link points to the correct file and location. Fig No II.3.8 The link ed image cannot be display ed. The file may hav e been mov ed, renamed, or deleted. Verify that the link points to the correct file and location. Fig No II.3.9 Table No.II.3.11 Locomotor Impaired Persons Educational Status (per 000' impaired persons) 1991-2002 Educational Status Rural Non-literate Primary Middle Secondary Higher-secondary Graduation and above Not Reported ALL 2002 Urban 486 290 128 53 29 14 1 1000 Rural 318 301 162 92 65 59 1 1000 1991 Urban 619 250 72 33 13 6 7 1000 397 220 129 72 37 37 8 1000 Source: NSSO Survey rounds 47th and 58th, 1991 and 2002. Locomotor Impaired Persons, Work Activity Status The NSSO survey (2002) has reported that 39.7 % of locomotor impaired persons in rural areas are without any source of income and those earning are employed in low profile jobs like; attending domestic chores, casual labourer, self employed in non-agriculture activities etc; Only 12.3 % locomotor impaired persons are self employed in agriculture, while 5 % were self employed in nonagricultural activities. In the case of urban areas 38.6 % locomotor-impaired persons are without any source of income. Only 9.5 % persons are regular employees and the rest are either casual workers or attending domestic chores or engaged in other low profile jobs. Significantly the proportion of locomotor impaired persons activity status has recorded very few changes in 2002 as compared to 1991 in rural areas. The proportion of self-employed in agriculture activities has shown significant increase during 1991-2002 for urban areas and consequently the proportion of selfemployed in non-agricultural activities had declined during this decade. Only a handful of organizations provide training in industry related skills to disabled people. Majority of the NGOs provide training in skills like arts and crafts, making stationary items, etc., which limit their options to self-employment. (Refer Table No. II.3.12 and Figure No. II.3.10). Role of NGOs Vis-à-vis The Employment Scenario in India with reference to People with Disabilities, NCPEDP and The National Association for the Blind, Delhi, Research Study. Table No.II.3.12 Locomotor Impaired Persons Work Activity Status (per 000' impaired persons) 1991-2002 Source: NSSO Survey rounds 47th and 58th, 1991 and 2002. Work Activity Status Rural Self Employed in Agriculture Self Employed in Non-Agriculture Regular Employee Casual Employee Unemployed Attending Education Institution Attending domestic work Begging Others ALL 2002 Urban 123 50 26 80 9 186 123 5 397 1000 1991 Rural 119 23 95 51 15 172 126 13 386 1000 Urban 129 51 27 87 17 112 88 54 164 121 6 415 1000 235 116 10 368 1000 Locomotor Impaired Persons, Work Activity Status after disability: The work activity status before and after the disability reported by the NSSO survey (2002) indicates that 36.8 % locomotor impaired persons were working before the onset of disability in rural areas, but 57.2% of them have lost job because of disability, while 17.3% have changed jobs and 25.5 % are still working in the same job. In the case of urban areas, 35.7 % were working before the onset of disability, but 45.9 % of them have lost the job because of disability, while 16.3 % have changed the jobs and the rest 29.8 % are still working in the same job. Thus the disability has significantly affected the economic status of the locomotor impaired persons in terms of loss of job as well as change of job. Thus appropriate measures need to be taken to counter the loss of job activity for the disabled through appropriate training, development of skill and providing employment opportunities in such skills. (Refer Table No. II.3.13 and Figure No. II.3.11) Table No.II.3.13 Locomotor Impaired Persons Work Activity Status- Before and After disability (Per 000' impaired persons) 1991-2002 Work Status 2002 1991 Rural Before Disability $ After Disability Urban 368 572 Rural 322 538 Urban 357 459 270 435 Loss of Work 173 163 193 158 Change of Work 255 298 348 405 Same Work ALL 1000 1000 1000 1000 Work Activity Status before disability per 1000 disabled Source: NSSO Survey rounds 47th and 58th, 1991 and 2002. The link ed image cannot be display ed. The file may hav e been mov ed, renamed, or deleted. Verify that the link points to the correct file and location. Fig No II.3.10 The link ed image cannot be display ed. The file may hav e been mov ed, renamed, or deleted. Verify that the link points to the correct file and location. Fig No II.3.11 Hearing Impaired Persons Magnitude, Composition and Characteristics Hearing Impaired Persons: The NSSO defined the hearing disability as a person's inability to hear properly. • The definition covered persons who could not hear at all, or could hear only loud sounds or could hear only shouted words or could hear only when the speaker was sitting in the front, or would usually ask to repeat the words spoken or would like to see the face of the speaker. Hence perhaps the NSSO definition left out mild hearing impaired persons and only observable and obvious hearing impaired persons were covered in NSSO survey. • The Planning Commission and the PWD-Act- 1995 have adopted the definition that a person shall be deemed to be deaf if he/she has loss of 60 decibels (db) or more in the better ear in the conversational range of frequencies. • The Rehabilitation Council of India considers hearing impairment as loss of 70 db and above in the better ear or total loss of hearing in both ears. Hearing Impaired Persons, Magnitude: Several estimates have indicated that there are over 123 million persons with hearing loss (41 or more db, in need of special services) in the World. Majority of these are living in South Asian Countries. At the national level, according to the Census Report of India 1931 there were 231,000 deaf-mutes in India, and it had a rider given by M.W.M. Yeats, the then Census Commissioner, that the figure was only indicative and the method of data collection was not convincing to the authorities. A study conducted by the Indian Council of Medical Research has estimated that 6.8 % people in the urban areas and 10.8 % people in rural areas had significant hearing losses. According to the NSSO 58th round (2002) nearly 3.06 million persons constituting 16.55% of all the disabled population (18. 49 million) in India were hearing impaired. The reported hearing impaired persons as per the NSSO survey have shown a marginal decline from 3.2 million in 1991 to 3.06 million in 2002. The proportion of hearing-impaired persons to all disabled persons has come down from 20.06% in 1991 to 16. 55% in 2002, which is significant and indicates appropriate preventive measures taken by the WHO ( 1998) : The World Health Report Life in the 21st Century : a Vision for All, Report of the Director General, Geneva , WHO. Rehabilitation Council of India ( 2000) : Status of Disability in India 2000. pp.98. ICMR ( 1983): Collaborative Study on Prevalence and Actiology of Hearing Impairment, New Delhi , ICMR and DST. The link ed image cannot be display ed. The file may hav e been mov ed, renamed, or deleted. Verify that the link points to the correct file and location. Fig No II.4.1 The link ed image cannot be display ed. The file may hav e been mov ed, renamed, or deleted. Verify that the link points to the correct file and location. Fig No II.4.2 Hearing Impaired Persons, Inter-state Prevalence Rate: The prevalence rate of hearing impaired males has depicted significant declining trends in majority of the states both in case of rural and urban areas during 1991 - 2002. In the case of rural areas significant decline in 2002 as compared to 1991 was recorded for Andhra Pradesh, Karnataka, Tamil Nadu, West Bengal and Madhya Pradesh. The prevalence rates among the hearing impaired males in rural areas were lowest for Jammu and Kashmir, Punjab, Haryana, Uttar Pradesh, Uttranchal, Rajasthan, Madhya Pradesh, Bihar, Jharkhand, West Bengal, Andhra Pradesh, Karnataka and all Easter states except for Arunachal Pradesh. Medium level prevalence rates were recorded in Tamil Nadu, Kerala, Maharastra and Jharkhand In the case of urban areas hearing impaired males recorded declining trends for prevalence rates in Andhra Pradesh, Tamil Nadu, Assam and Punjab . The prevalence rate among hearing impared males was highest for Orrisa. All other states recorded uniform lower prevalence rates among males in urban areas. (Refer Map No. II.4.1 and Table No. II.4. 3) The prevalence rate for hearing impaired women for rural areas has also decreased significantly during 1991 to 2002 in Orissa, Tamil Nadu and Andhra Pradesh. Hearing impaired women recorded lower prevalence rates among rural areas in majority of the states. However medium level prevalence rates were recorded in Orissa, Kerala, Himachal Pradesh, Tamil Nadu, Andhra Pradesh, Uttranchal , Sikkim and Arunachal Pradesh. In the case of urban areas except for Kerala, Tamil Nadu and West Bengal , prevalence rates for women were lowest in all other states. Sharp decline in prevalence rates for hearing impaired women was observed in Orissa, Andhra Pradesh and Maharastra in 2002 as compared to 1991. (Refer Map No. II.4.2 and Table No. II.4.4) Table No.II.3.3 India Hearing Impaired Persons Prevalence Rate (Per 100,000) MALES STATES 1991 A.P. Andaman & N. Isl. Arunachal Pradesh Assam Bihar Chandigarh Chhatisgarh D & N Haveli Daman & Diu Delhi Goa Gujraat H.P. Haryana J&K Jharkhand Karnataka Kerala Lakshadeep RURAL 2002 657 358 335 352 1601 477 603 513 URBAN 1991 336 617 635 155 241 99 472 132 137 109 467 363 687 264 284 278 314 410 420 2002 476 410 241 293 233 423 346 314 233 219 0 177 188 83 380 78 142 29 15 270 213 218 173 125 158 355 591 M.P. Maharashtra Manipur Meghalaya Mizoram Nagaland Orrisa Pondicherry Punjab Rajasthan Sikkim Tamil Nadu Tripura U.P. Uttaranchal West Bengal All India 479 554 765 466 329 722 307 633 498 Source: NSSO round 47th and 58th, 1991 and 2001. 218 411 225 336 207 199 642 335 225 194 974 425 99 269 282 343 319 339 319 486 275 204 483 231 341 325 178 250 186 140 127 107 467 749 131 182 211 374 148 192 107 362 234 The image cannot be display ed. Your computer may not hav e enough memory to open the image, or the image may hav e been corrupted. Restart your computer, and then open the file again. If the red x still appears, y ou may hav e to delete the image and then insert it again. Table No.II.3.4 India Locomotor Impaired Persons Prevalence Rate (Per 100,000) FEMALES STATES 1991 A.P. Andaman & N. Isl. Arunachal Pradesh Assam Bihar Chandigarh Chhatisgarh D & N Haveli Daman & Diu Delhi Goa Gujraat H.P. Haryana J&K Jharkhand Karnataka Kerala Lakshadeep M.P. Maharashtra Manipur Meghalaya Mizoram Nagaland Orrisa Pondicherry Punjab Rajasthan Sikkim Tamil Nadu Tripura U.P. Uttaranchal West Bengal All India RURAL 2002 662 273 177 389 672 460 585 501 421 503 632 398 207 724 266 502 435 Source: NSSO round 47th and 58th, 1991 and 2001. Table No.II.3.4 India URBAN 1991 420 311 532 179 137 83 374 72 248 0 426 308 643 199 186 130 333 517 343 187 349 210 310 250 179 563 754 254 190 988 473 111 258 414 282 301 2002 526 311 182 344 242 338 318 436 220 432 621 179 188 553 220 386 355 211 53 14 215 156 36 298 105 163 34 467 201 266 199 179 139 155 449 929 178 258 195 65 179 153 393 1096 160 121 94 407 208 177 51 434 238 Locomotor Impaired Persons Prevalence Rate (Per 100,000) FEMALES STATES 1991 A.P. Andaman & N. Isl. Arunachal Pradesh Assam Bihar Chandigarh Chhatisgarh D & N Haveli Daman & Diu Delhi Goa Gujraat H.P. Haryana J&K Jharkhand Karnataka Kerala Lakshadeep M.P. Maharashtra Manipur Meghalaya Mizoram Nagaland Orrisa Pondicherry Punjab Rajasthan Sikkim Tamil Nadu Tripura U.P. Uttaranchal West Bengal All India RURAL 2002 662 273 177 389 672 460 585 501 421 503 632 398 207 724 266 502 435 Source: NSSO round 47th and 58th, 1991 and 2001. URBAN 1991 420 311 532 179 137 83 374 72 248 0 426 308 643 199 186 130 333 517 343 187 349 210 310 250 179 563 754 254 190 988 473 111 258 414 282 301 2002 526 311 182 344 242 338 318 436 220 432 621 179 188 553 220 386 355 211 53 14 215 156 36 298 105 163 34 467 201 266 199 179 139 155 449 929 178 258 195 65 179 153 393 1096 160 121 94 407 208 177 51 434 238 The image cannot be display ed. Your computer may not hav e enough memory to open the image, or the image may hav e been corrupted. Restart your computer, and then open the file again. If the red x still appears, y ou may hav e to delete the image and then insert it again. Table No.II.3.4 India Locomotor Impaired Persons Prevalence Rate (Per 100,000) FEMALES STATES 1991 A.P. Andaman & N. Isl. Arunachal Pradesh Assam Bihar Chandigarh Chhatisgarh D & N Haveli Daman & Diu Delhi Goa Gujraat H.P. Haryana J&K Jharkhand Karnataka Kerala Lakshadeep M.P. Maharashtra Manipur Meghalaya Mizoram Nagaland Orrisa Pondicherry Punjab Rajasthan Sikkim Tamil Nadu Tripura U.P. Uttaranchal West Bengal All India RURAL 2002 662 273 177 389 672 460 585 501 421 503 632 398 207 724 266 502 435 Source: NSSO round 47th and 58th, 1991 and 2001. URBAN 1991 420 311 532 179 137 83 374 72 248 0 426 308 643 199 186 130 333 517 343 187 349 210 310 250 179 563 754 254 190 988 473 111 258 414 282 301 2002 526 311 182 344 242 338 318 436 220 432 621 179 188 553 220 386 355 211 53 14 215 156 36 298 105 163 34 467 201 266 199 179 139 155 449 929 178 258 195 65 179 153 393 1096 160 121 94 407 208 177 51 434 238 The image cannot be display ed. Your computer may not hav e enough memory to open the image, or the image may hav e been corrupted. Restart your computer, and then open the file again. If the red x still appears, y ou may hav e to delete the image and then insert it again. Hearing Impaired Persons, Prevalence Rate- Age Groups: The Prevalence rates of hearing impaired among the children below 4 years was 55 both in rural and urban areas. In the case of younger children and adolescent (5 to 24 years) it was hovering around 170 -200 for rural areas and 150 for urban areas respectively. The rates were marginally higher for the rural areas compared to urban areas among 5-24 age groups. However prevalence rates have declined for children and adolescents during 1991 2002 in case of both rural and urban areas. The prevalence rates showed progressively increasing trends both for rural and urban areas from the age of 25- 60 years. The prevalence rate was highest for the persons above 60 years of age both for rural and urban areas. However substantial decline in the prevalence rate was registered from 1991 for age groups above 60 years both for rural and urban areas. The decline was more pronounced in the case of urban areas, probably due to better healthcare and use of aids and appliances. Thus age composition is closely associated with the prevalence rates of hearing impaired persons. Thereby indicating that preventive measures through proper diet, diagnosis, healthcare and availability of aids and appliances are required in the later age groups. A significant decline in the prevalence rates of hearing impaired persons was observed in all the age groups and especially for the older age groups (Above 60 years) during 1991 and 2002. (Refer Table No.II.4.5 and Figure No. II.4.3) Table No. II.4.5 Hearing Impaired Persons Prevalence Rate (Age wise): Age Group Rural 0-4 5-9 10-14 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60+ 5 & Above Urban 55 172 196 193 200 205 207 235 261 292 453 537 1551 310 2002 Rural 55 142 209 145 118 120 134 135 143 219 213 391 1385 236 1991 Urban 236 263 245 204 225 250 258 343 495 586 836 2338 467 184 192 181 147 158 144 195 212 281 461 609 2218 339 1991- 2002 Source: NSSO round 47th and 58th, 1991 and 2001. Hearing Impaired Persons, Incidence Rate: The incidence rate (reported cases of hearing impaired persons per 100,000 persons during the last 365 preceding the NSSO survey in 2002) for the hearing impaired persons in India has come down from 15 to 8 for rural areas and from 12 to 7 for urban areas during 1991- 2002. This indicates improvement has taken place to prevent the disability through preventive and curative measures. The incidence rate for males was 10 and 8 and for females 7 and 7 respectively for rural and urban areas in 2002. Incidence rates have shown decline in 2002 between both genders in rural and urban areas compared to 1991 figures. (Refer Table No. II.4.6 and Figure No. II.4.4) Table No. II.4.6 Hearing Impaired Persons Incidence Rate (per 100,000 persons) Hearing Impaired Rural Male 2002 1991 Urban 10 Rural 8 Urban 16 11 Female 7 7 14 14 Persons 8 7 15 12 Source: NSSO Survey Round 47 th and 58 th in 1991 and 2002. Incidence rate is reported disabled persons during the last 365 days from the date of the survey per 100,000 persons. Hearing Impaired Persons, Incidence Rate- Age Group: The incidence rates of hearing impaired persons up to age of 55 years were insignificant, hovering around 0-5 per 100,000 persons both among the rural and urban areas in 2002. However the incidence rates for the hearing impaired persons increased progressively from 55 years onwards and it was hovering around 13-23 for rural and urban areas respectively among age groups of 55-60 years. Age groups above 60 years registered incidence rate of 70- 73 respectively for urban and rural areas. Insignificant rural/ urban variations in the incidence rates were found among rural and urban areas. A significant decline in the incidence rates for the hearing impaired was recorded from 1991 for all age groups, particularly for age groups of 60 years and above both for rural and urban areas (Refer Table No.II.4.7 and Figure No. II.4.5). The link ed image cannot be display ed. The file may hav e been mov ed, renamed, or deleted. Verify that the link points to the correct file and location. Fig No II.4.3 The link ed image cannot be display ed. The file may hav e been mov ed, renamed, or deleted. Verify that the link points to the correct file and location. Fig No II.4.4 The link ed image cannot be display ed. The file may hav e been mov ed, renamed, or deleted. Verify that the link points to the correct file and location. Fig No II.4.5 Age Group Rural 0-4 5-9 10-14 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60+ 2002 Urban 1 2 3 1 2 0 1 3 3 3 6 13 73 1991 Rural 3 2 1 0 1 1 3 1 1 3 3 23 70 Urban 11 4 4 3 5 5 2 8 8 23 20 104 7 6 3 2 2 2 4 7 3 24 32 105 5 & Above 8 7 15 12 Hearing Impaired Persons Incidence Rate -Age Wise 1991-2002: Source: NSSO Survey Round 47 th and 58 th in 1991 and 2002. Incidence rate is reported disabled persons during the last 365 days from the date of the survey per 100,000 persons. Hearing Impaired Persons, Age Groups at onset of Impairment: The NSSO 58 th round estimated the age at onset of disability for the cohort of persons aged 60 years and above, who have acquired hearing impairment. The results depicts that hearing impairment is an old age problem. It seems to start progressing at the age somewhere 55 years, as about 82- 85 percent hearing-impaired persons acquired the impairment after the age of 45 years. About 55-62 percent hearing impaired persons acquired it after the age of 60 years. Significantly nearly 5-7 percent persons have acquired visual impairment since birth. (Refer Table No. II.4.8 and Figure No. II.4.6) Prevalence of hearing disability from birth was also reported for all hearing impaired persons enumerated by the NSSO survey 2002. The data depicts that 39.3%, 34.5% and 37.0 % male, female and both male and females were hearing impaired from birth, thereby indicating probable causes due to heredity or malnutrition of pregnant mothers or due to inappropriate delivery services at the time of birth. Table No. II.4.8 Hearing Impaired Persons (Distribution of 1000 persons) Age at onset of Impairment for Cohort persons above 60 years (1991-2002) Age Group Rural Since Birth 0-4 5-9 10-19 20-44 45-59 60+ 2002 Urban 68 7 7 20 84 257 557 Rural 53 5 14 20 76 215 618 1991 Urban 9 6 21 74 280 609 7 13 21 91 215 651 Source: NSSO Survey Round 47 th and 58 th in 1991 and 2002. Hearing Impaired Persons, Degree of Impairment: There are several kinds of hearing impairment, as all hearing impairments are not of the same severity. Common clinical experience in audiology, otological and special educational practice suggests that individuals with similar audiometric profiles will both describe and exhibit a wide range of hearing difficulties. The NSSO data of 2002 has identified hearing impairment in terms of profound, severe and moderate cases. The data depicts that among the hearing impaired persons 31.1% cases had profound, while 39.8% cases had severe and the rest 29% cases had moderate hearing impairment in the rural areas. In the case of urban areas 34.5% had profound, 36.2% had severe while the rest 29.3 % have moderate hearing impairment. Significantly the proportion of profound and severe hearing impairment cases both for rural and urban areas have increased in 2002 compared to 1991. (Refer Table No. II.4.9 and Figure No. II.4.7) Nagaraja, M.N ( 1996): Impact of hearing handicap and its rehabilitation management, Bihar Journal of Otolaryngology, Vol.16 Table No. II.4.9 Hearing Impaired Persons Degree of Impairment per 000 hearing impaired persons Degree of Impairment Rural Profound Severe Moderate 2002 Urban 311 398 290 Rural 345 362 293 1991 Urban 229 357 408 207 324 460 Source: NSSO Survey Round 47 th and 58 th in 1991 and 2002. Hearing Impaired Persons, Causes: A World Health Organization, 1980 report identified infections, neglect and ignorance as the major causes of hearing impairment. All the three have bearing on prenatal, natal and postnatal situations, which can cause hearing impairments. Infections in the prenatal/ natal and postnatal stage may occur due to toxoplasmosis, syphilis, bacterial meningitis, rubella, cytomegalogy, herpes, measles, mumps, chicken pox, encephalitis, diphtheria, tetanus, whooping cough, pneumonia and ear infections. Neglect in the prenatal/ natal and postnatal stage may be due to malnutrition of pregnant mother, non-immunization of pregnant mother, unaware of Rh incompatibility factor, inappropriate healthcare to diseases like T.B, malaria, epilepsy during pregnancy, inappropriate and less satisfactory delivery conditions, non-professional approach in handling complicated delivery cases resulting in prolonged asphyxia, trauma or infection. Neglect of ear, nose and throat infections, excessive exposer to loud noise without ear protection, neglect of head and ear tumours also cause hearing impairments. Ignorance towards health and hygiene, nutrition and immunization of pregnant mothers and consanguineous marriages leading to hereditary defects are also reported to lead hearing impairments. Iodine deficiency, Vitamin A deficiency and fluorosis were found to be a cause for higher incidence of deafness in many cases. A report from NIMHANS shows that 35% of children with learning impairment had Central Auditory Processing Disorders (CAPD). NSSO survey 58 th round in 2002 has identified several causes for hearing impairment. The common cause for hearing impairment was found old age, other illness, ear discharge, injury other than burns, noise induced hearing loss, German measles, rubella, medical surgical interventions etc;. (Refer Table No. II.4.10 and Figure No. II.4.8) Fig No II.4.7 The link ed image cannot be display ed. The file may hav e been mov ed, renamed, or deleted. Verify that the link points to the correct file and location. F i g The link ed image cannot be display ed. The file may hav e been mov ed, renamed, or deleted. Verify that the link points to the correct file and location. N o I I . 4 . 8 F i g No II.4.6 The link ed image cannot be display ed. The file may hav e been mov ed, renamed, or deleted. Verify that the link points to the correct file and location. Table No. II.4.10 Hearing Impaired Persons Cause per 000' hearing impaired persons: 1991-2002 Cause of Impairment Rural German measles/ rubella Noise induced hearing loss Ear discharge Other illness Burns Injury other than burns Medical/ surgical intervention Old age Other reasons Not known 2002 Urban 6 17 165 229 2 47 14 254 77 183 Rural 8 31 132 221 2 59 22 295 99 128 1991 Urban 9 17 175 186 2 35 10 230 77 259 14 18 143 197 2 52 21 259 88 206 Source: NSSO Survey Round 47 th and 58 th in 1991 and 2002. Prevention and Early Detection measures The combination of preventive and curative measures is essential to reduce the prevalence and incidence rates for hearing impairment. Some of the preventive measures are: • Measures of immunization: Expanded Programme of Immunization (EPI) launched by WHO in 1974 has been incorporated in the National Health Policy of 1983. • National Iodine Deficiency Disorder Control Programme (NIDDCP): The programme was started in 1986 to provide iodine a major cause for diseases like goitre, mental retardation and hearing impairment. • Child Survival and Safe Motherhood Programme: Among the preventive measures Integrated Child Development Scheme (ICDS) is implemented through anganwadi workers. The aim is to improve the nutritional intake and health status of children in the age group of 0-6 years. It also provides nutrition and health education for all women in the age group of 15-44 years. Specific programmes of early detection were initiated in the primary health centres with the help of voluntary and private organizations. These measures have helped to bring down the prevalence and incidence rates for hearting impairments, which have been indicated by the NSSO survey of 2002. Hearing Impaired Persons, Education Status: The education status of hearing impaired persons depicted by the NSSO survey (2002) presents a bleak picture. Among the hearing impaired persons in rural areas 69.5% were illiterate, 21.1% were educated only up to primary level, 6% were educated up to middle level, 2% were educated up to secondary level and only 1 % had attained education above secondary level. In the case of urban areas 46.3% hearing-impaired persons were illiterate, 30.6% were educated up to primary level, 11% up to middle level, 6.7% up to secondary level and 6% above secondary level. Marginal changes in the education status of the hearing impaired persons were observed during 1991-2002, thereby indicating that the government measures as a result of the PWD-Act 1995 and the awareness generated by the civil society organization has limited impact to expand the coverage of education for hearing impaired persons. The education status of hearing impaired persons indicates very poor response to the schemes specially meant for the disabled. A significant proportion of hearing disabled children are not enrolled in any schools. The gap is more pronounced between rural and urban areas. These children require specialised education programmes, as integrated school programme may not be useful for hearing impaired persons. Even the educational reservation as stipulated in the PWD Act of 1995 seems to be a non-starter for hearing impaired persons. The role of voluntary sector and private sector needs to be emphasised to in order to cover children with hearing impairments. Higher education for the hearing disabled is eluding, hence job reservations for the hearing disabled are not fully utilized in the absence of qualified and skilled available manpower. (Refer Table No.II.4.11 and Figure No. II.4.9). Table No.II.4.11 Hearing Impaired Persons Educational Status 1991- 2002 (per 000' disabled) Source: NSSO Survey Round 47 th and 58 th in 1991 and 2002. Educational Status Rural Non-literate Primary Middle Secondary Higher-secondary Graduation and above Not Reported ALL Urban 695 211 60 21 9 2 1 1000 2002 Rural 463 306 110 67 28 26 1 1000 1991 Urban 774 166 34 12 5 1 9 1000 511 296 90 57 15 22 8 1000 Hearing Impaired Persons, Work Activity Status: The NSSO survey (2002) has reported that 61% of hearing impaired persons in rural areas are without any source of income and those earning are employed in low profile jobs like; attending domestic chores, casual labourer, begging etc; Only 8 % hearing impaired persons are self employed in agriculture, while 3.7% were self employed in non-agricultural activities. In the case of urban areas 57.4% hearing-impaired persons are without any source of income. Only 2.5% persons are regular employees and the rest are either casual workers or attending domestic chores or engaged in other low level jobs. Significantly the proportion of hearing impaired persons engaged in self-employed agricultural activities, casual employees and attending domestic chores have declined in 2002 compared to 1991 in rural areas. With the result majority of them have lost the only source of income. This could be probably as a result of globalisation and stiff competition faced by the workers. Hence the PWD Act- 1995 has not improved the employment / sources of earning scenario for the hearing impaired persons contrary to the expectation. (Refer Table No. II.4.12 and Figure No. II.4.10) Table No.II.4.12 Hearing Impaired Persons Work Activity Status 1991- 2002 (per 000' disabled) Work Activity Status Rural Urban Self Employed in Agriculture 84 Self Employed in Non-Agriculture 37 Regular Employee 5 Casual Employee 69 Unemployed 3 Attending Education Institution 37 Attending domestic work 149 Begging 7 Others 610 ALL 1000 2002 Rural 80 12 25 41 3 62 196 6 574 1000 1991 Urban 181 12 14 149 24 103 69 70 57 163 5 389 1000 93 229 3 410 1000 Source: NSSO Survey 47 th and 58th round in 1991 and 2002 Hearing Impaired Persons, Work Activity Status Before and After Impairment: The work activity status before and after the hearing impairment reported by the NSSO survey (2002) indicates that 52.8% hearing-impaired persons were working before the onset of disability, but 23.8% of them have lost job because of the impairment, while 8.5% have changed jobs and 67.6 % are still working in the same job in rural areas. In the case of urban areas, 42.9% were working before the onset of disability, but 24.5% of them have lost the job because of the impairment, while 8% have changed the jobs and the rest 67.4% are still working in the same job. Thus the impairment has marginally affected the economic status of the hearing impaired persons in terms of loss of job as well as change of job. Appropriate measures need to be taken to counter the loss of job activity for the disabled through appropriate training, development of skill and providing employment opportunities in such skills. (Refer Table No.II.4.13 and Figure No. II.4.11) Table No. II.4.13 Hearing Disabled Persons Work Activity Status, Before and After Disability, (Per 000' disabled) 1991-2002 Work Status 2002 1991 Rural Before Disability $ After Disability Urban 528 238 Rural 429 245 Urban 423 242 311 289 Loss of Work 85 81 87 69 Change of Work 676 674 632 640 Same Work ALL 1000 1000 1000 1000 Source: NSSO Survey 47 th and 58th round in 1991 and 2002 Work Activity Status before disability per 1000 disabled The link ed image cannot be display ed. The file may hav e been mov ed, renamed, or deleted. Verify that the link points to the correct file and location. Fig No II.4.9 The link ed image cannot be display ed. The file may hav e been mov ed, renamed, or deleted. Verify that the link points to the correct file and location. Fig No II.4.10 The link ed image cannot be display ed. The file may hav e been mov ed, renamed, or deleted. Verify that the link points to the correct file and location. Fig No II.4.11 PART II Visually Impaired Persons Magnitude, Composition and Characteristics Visually Impaired Persons: According to the (PWD ACT 1995, India) Visual impairment and disability refers to a condition where a persons suffers from: • Blindness: A condition where a person suffers from any of the following conditions namely: • Total absence of sight or • Visual acuity not exceeding 6/60 or 20/200 (snellen) in the better eye with correcting lenses; or • Limitation of the field vision subtending an angle of 20 degree or worse. • Person with low vision: 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. This definition has been adopted from the WHO (1992) definition which states that a person with low vision is one who has impairment of visual functioning even after treatment and or/ standard refractive correction, and has a visual acuity of less than 6/18 to light perception or a visual field of less than 10 degree from the point of fixation, but who uses, or is potentially able to use vision for the planning or execution of a task. Visually Impaired Persons, Magnitude: Several estimates have indicated that there are about 45 million blind persons and an additional 135 million persons who suffer from low vision conditions in the World, and 90 % of these persons are from developing nations. According to the International Council for Education of People with Visual Impairment (ICEVI), 35 million people in the World are blind, out of them 23 million live in Asia , 7 million in Africa , 2.5 million in Latin America and 2.5 million in rest of the World. The WHO- PBD Data Bank reports that there are about 38 million blind and around 110 million people with low vision. At the national level there are varying statistics on magnitude and incidence of visual impairment in India . The WHO- PBD Data Bank states that 8.9 million people are blind in India . As per the global statistics on blindness 1998, India has approximately 10 million blind persons requiring services. Other surveys estimated that about 12 million are blind and 28.5 million are partially visually impaired. A National Sample of blindness conducted during 1986-89 under the aegis of the Ministry of Health and Family Welfare estimated that 11.92 million persons are blind. According to the National Programme for Control of Blindness about 28.56 million persons are with low vision. The NSSO 37 th and 47 th round, collected data for visually impaired (both blind and low vision persons together) while the NSSO 58 th round collected data separately for blind and the persons with low vision. According to the NSSO 58th round (2002) nearly 2.82 million persons constituting 15.28% of all the disabled population (18. 49 million persons in India ) were visually impaired (both blind and with low vision). About 10.88%-disabled persons were blind and 4.32% persons were with low vision. According to the NSSO 58 th round (2002) about 2.013 million persons were blind and 813,000 persons were having low vision in India . The reported visual impairment persons as per the NSSO survey have shown a significant decline from 4 million persons in 1991 to 2.82 million persons in 2002. The proportion of visually impaired persons to all disabled persons has also come down from 24.79% in 1991 to 15. 28% in 2002, which is significant and indicates appropriate preventive and protective measures were taken by the government to prevent visual impairment cases. Of the total visual impaired persons nearly 54% were females and the rest 46% were males in 2002, depicting a females gender bias because of prevalence of malnutrition among pregnant mothers and social and economic obstacles for females especially in the early ages. (Refer Table No. II.5.1 and Figure No. II.5.1) Table No.II.5.1 Visually Impaired Persons Magnitude (in 000) Visual Disability Type Male Blindness Low Vision Both 2002 Female 928 369 1298 Both 1084 444 1528 1991 Male 2013 813 2826 Female Both 1487 2158 4005 Visually Impaired Persons, Prevalence Rate: The prevalence rate for the visually impaired persons in India has come down from 525 to 296 for rural areas and from 302 to 194 for urban areas during 1991- 2002. This indicates significant improvement has taken place to prevent the impairment through preventive and curative measures. Among the visually impaired persons, 72% were blind and 28% had low vision in 2002. The prevalence rates were substantially higher among the females as compared to the males both in 1991 and 2002. The prevalence rate for blind persons was 210 in rural areas and 140 in urban areas, while it was 86 in rural areas and 54 for urban areas for low vision persons in 2002. (Refer Table No. II.5.2) Table No. II.5. 2 Visually Impaired Persons Prevalence Rate (per 100,000 persons) Visual Disability Type Rural Urban 191 Blindness 2002 Rural 116 Male 230 166 Female 210 140 Persons Low Vision 76 46 Male 95 62 Female 86 54 Persons Both 1991 Urban 471 263 Male 267 162 548 346 Female 325 228 525 302 Persons 296 194 Source: NSSO Survey Round 47 th and 58 th in 1991 and 2002. Prevalence rate is number of disabled persons to 100,000 persons Blind Persons, Inter-State Prevalence Rate: The prevalence rate of blind males for rural areas in 2002 was higher in Himachal Pradesh, Uttar Pradesh, Meghalaya, Orissa, Maharastra and Karnataka. State of Jammu and Kashmir , Uttranchal, Haryana, Rajasthan, West Bengal , Jharkhand, Chattisgarh, Madhya Pradesh, Gujarat , Andhra Pradesh, Tamil Nadu and Pondicherry registered medium level prevalence rates for blind males in rural areas. Least prevalence rates were recorded among blind males for rural areas in Mizoram and Tripura. In the case of urban areas prevalence rate among blind males was exceptionally high for Pondicherry . Medium level prevalence rate for blind males in urban areas were recorded in West Bengal , Goa , Lakshwappep, Kerala and Tamil Nadu. Other states recoded lower prevalence rates for blind men in urban areas. The prevalence rates for blind women were comparatively higher than males in majority of states in rural areas. Higher prevalence rate for women in rural areas were found in Himachal Pradesh, Uttranchal, Uttar Pradesh, Orissa, Chattisgarh, Madhya Pradesh, Maharastra, Andhra Pradesh, Karnataka, Lakshwadeep, Kerala and Pondicherry. In case of urban areas prevalence rate among blind women was high for Pondicherry , Lakshwadeep, Maharastra, Orissa, West Bengal , and Jammu and Kashmir . It was medium level for Madhya Pradesh, Andhra Pradesh and Tamil Nadu, while it was low for all union territories and states of Goa , Manipur and Mizoram. (Refer Map No. II.5.1 and Table No. II.5. 3) Table No. II.5.3 India Blind persons Prevalence Rate (Per 100,000)- 2002 STATES Male A.P. Andaman & N. Isl. Arunachal Pradesh Assam Bihar Chandigarh Chhatisgarh D & N Haveli Daman & Diu Delhi Goa Gujraat H.P. Haryana J&K Jharkhand Karnataka Kerala Lakshadeep M.P. Maharashtra Manipur Meghalaya Mizoram Nagaland Orrisa Pondicherry Punjab Rajasthan Sikkim Tamil Nadu Tripura U.P. Uttaranchal West Bengal All India RURAL Female 191 100 84 110 143 66 155 121 21 86 0 156 286 161 196 162 229 148 83 171 231 68 214 35 70 325 166 201 163 61 184 45 234 179 159 191 Source: NSSO Survey round 58 th in 2002 URBAN Male 294 113 191 110 145 0 201 125 42 0 27 192 295 137 163 97 280 205 284 264 263 47 78 12 119 287 245 195 209 62 189 95 311 291 188 230 Female 114 22 23 141 97 47 143 19 20 32 160 76 119 85 68 69 89 195 162 157 110 65 42 53 42 148 404 117 79 21 171 95 105 74 189 116 185 26 14 133 124 28 119 21 47 10 0 91 106 70 220 45 113 140 337 178 277 35 68 34 92 248 410 97 109 71 197 128 145 76 251 166 The image cannot be display ed. Your computer may not hav e enough memory to open the image, or the image may hav e been corrupted. Restart your computer, and then open the file again. If the red x still appears, y ou may hav e to delete the image and then insert it again. Low Vision Persons, Inter-State Prevalence Rate: The prevalence rate for low vision impaired men for rural areas in 2002 was high for Orissa, while it was medium for Andhra Pradesh, Karnataka, Kerala , West Bengal, Meghalaya, Uttranchal and Himichal Pradesh. Low prevalence retes for low vision impaired males in rural areas were for Rajasthan, Haryana, Gujarat , Madhya Pradesh and Jharkhand. In the case of urban areas for 2002, the prevalence rate for low vision impaired men was generally low for all states except for Chattisgarh, Himachal Pradesh, Kerala , Jammu and Kashmir , Orissa, West Bengal , Tamil Nadu and Madhya Pradesh. Among women the prevalence rate for low vision impaired in rural areas for 2002 was highest for Orissa, Arunachal Pradesh and Meghalaya followed by Andhra Pradesh and Karnataka. Other states recorded medium to low prevalence rates for low impaired women in rural area. In case of urban areas, the prevalence rate for low vision impaired women was high in Orrisa, Kerala, Jharkhand and Nagaland, followed by West Bengal, Jammu and Kashmir and Tamil Nadu. Other states recoded low to moderate prevalence rate for low vision impaired women in urban areas for 2002. (Refer Map No. II.5.2 and Table No. II.5.4) Table No. II.5.4 India Low Vision persons Prevalence Rate (Per 100,000)- 2002 STATES Male A.P. Andaman & N. Isl. Arunachal Pradesh Assam Bihar Chandigarh Chhatisgarh D & N Haveli Daman & Diu Delhi Goa Gujraat H.P. Haryana J&K Jharkhand Karnataka Kerala Lakshadeep M.P. Maharashtra Manipur Meghalaya Mizoram Nagaland RURAL Female 101 229 63 51 52 0 90 16 0 5 127 40 138 26 100 25 117 116 26 30 78 61 125 72 83 URBAN Male 166 36 225 39 50 0 57 0 39 0 150 53 132 43 80 27 151 137 0 82 111 35 190 33 98 Female 41 0 0 48 42 16 190 39 0 15 0 24 143 23 108 10 22 132 81 63 33 53 1 21 40 83 0 0 89 61 28 158 21 47 15 0 18 48 30 118 10 45 167 195 29 36 74 68 4 232 Orrisa Pondicherry Punjab Rajasthan Sikkim Tamil Nadu Tripura U.P. Uttaranchal West Bengal All India 241 184 61 36 52 82 3 62 114 101 76 Source: NSSO Survey round 58 th in 2002 270 42 78 46 54 138 17 78 76 70 96 117 31 38 16 21 72 0 35 36 83 46 199 34 34 34 24 101 15 48 0 135 63 The image cannot be display ed. Your computer may not hav e enough memory to open the image, or the image may hav e been corrupted. Restart your computer, and then open the file again. If the red x still appears, y ou may hav e to delete the image and then insert it again. Visually Impaired Persons, Age Groups Prevalence Rate: The prevalence rates of blind persons and low vision persons among the children and adolescent (up to 19 years) were hovering around 30 50 and 5-20 per 100,000 persons respectively. The prevalence rates were marginally higher among the rural areas as compared to urban areas. Thus indicating rural/ urban bias in the prevalence of visual impairment, probably due to varying social, cultural and economic factors. The prevalence rates were around 50-75 for blind persons and 20-30 for low vision persons among adults up to age of 45 years. The prevalence rates showed increasing trends both for blind and low vision persons from the age of 45 years onwards. The prevalence rate was highest for the persons above 60 years of age for both visually impaired groups. Thus age composition is closely associated with the prevalence rates of visually impaired persons. Thereby indicating that preventive measures through proper diet, diagnosis, healthcare and availability of aids and appliances are required in the early and later age groups to prevent visual impairment. (Refer Table No.II.5.5 and Figure No. II.5.2 Table No. II.5. 5 Visually Impaired Persons Prevalence Rate (Age Groups) (per 100,000 persons)- 2002 Age Group Rural 0-4 5-9 10-14 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60+ 5 & Above Blindness Urban 32 48 52 56 65 68 77 75 128 183 266 431 1733 210 Low Vision Rural 30 73 82 44 56 43 30 53 79 105 182 283 1087 140 Urban 5 12 22 21 23 17 16 32 43 65 124 234 747 86 5 16 10 13 18 20 19 20 30 39 98 122 459 54 Source: NSSO Survey Round 47 th and 58 th in 1991 and 2002. Prevalence rate is number of disabled persons to 100,000 persons A significant decline in the prevalence rates of visually impaired persons was observed in all the age groups especially for the older age groups (Above 60 years) during 1991 and 2002. As compared to the prevalence rate for all visually impaired persons of 5060 for rural areas and 3253 for urban areas in 1991, it declined to 2480 for rural areas and 1546 for urban areas in 2002. Visually Impaired Persons, Incidence Rate: The incidence rate (reported cases of visually impaired persons per 100,000 persons during the last 365 preceding the NSSO survey in 2002) for the visually impaired persons in India has come down from 25 to 13 for rural area and from 20 to 9 for urban areas during 1991-2002. This indicates significant improvement has taken place to prevent the impairment through preventive and curative measures. The incidence rate for blind persons was 9 and 6 respectively for rural and urban areas while it was 4 and 3 for low vision persons respectively for rural and urban areas in 2002. The incidence rates for blind and low vision impaired were also higher for females compared to the males especially in rural areas. (Refer Table No. II.5.6) Table No. II.5.6 Visually Impaired Persons Incidence Rate (per 100,000 persons) 2002 Visual Disability Type Rural Urban 7 Blindness 2002 Rural 4 Male 11 7 Female 9 6 Persons Low Vision 3 3 Male 5 3 Female 4 3 Persons Both 1991 Urban 22 15 Male 10 7 28 25 Female 16 10 25 20 Persons 13 9 Source: NSSO Survey Round 47 th and 58 th in 1991 and 2002. Incidence rate is reported disabled persons during the last 365 days from the date of the survey per 100,000 persons. Visually Impaired Persons, Incidence Rate- Age Group: The incidence rates for blind persons, among the children, adolescent and adults (up to 45 years) were insignificant, hovering around 0-3 per 100,000 persons both among the rural and urban areas. However the incidence rates for the visually impaired persons increased from 45 years onwards progressively and it was hovering around 60-80 for blind persons and 20-40 for low vision persons for the ages above 60 years. Significant rural/ urban variations in the incidence rates were registered for the age groups above 55 years indicating variations in the availability of awareness and healthcare services among the rural and urban areas. The incidence rates for the visually impaired persons has shown sharp decline during 1991 and 2002 for all the age groups especially for the older age groups. Compared to the overall incidence rate of 225 for rural areas and 221 for urban areas for the 60 + age groups in 1991, it has declined to 120 for the rural areas and 82 for the urban areas for the same age groups in 2002. However the decline was more in urban areas compared to the rural areas, due to prevailing rural/ urban bias in the availability of healthcare services and awareness generation services. (Refer Table No.II.5.7 and Figure No. II.5.3) Table No.II.5.7 Visually Impaired Persons Incidence Rate -Age Wise (per 100,000 persons) 2002 Age Group Rural 0-4 5-9 10-14 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60+ 5 & Above Blindness Urban 2 1 1 1 1 1 0 1 2 10 17 26 81 9 Rural 3 0 1 0 0 1 0 2 0 4 12 14 59 6 Low Vision Urban 0 0 0 0 0 1 0 2 1 6 4 23 39 4 0 0 0 0 1 0 0 1 1 4 5 14 23 3 Source: NSSO Survey Round 47 th and 58 th in 1991 and 2002. Incidence rate is reported disabled persons during the last 365 days from the date of the survey per 100,000 persons. The image cannot be display ed. Your computer may not hav e enough memory to open the image, or the image may hav e been corrupted. Restart your computer, and then open the file again. If the red x still appears, y ou may hav e to delete the image and then insert it again. Fig No II.5.1 The link ed image cannot be display ed. The file may hav e been mov ed, renamed, or deleted. Verify that the link points to the correct file and location. Fig No II..2 The image cannot be display ed. Your computer may not hav e enough memory to open the image, or the image may hav e been corrupted. Restart your computer, and then open the file again. If the red x still appears, y ou may hav e to delete the image and then insert it again. Visually Impaired Persons, Age at onset of Impairment: The NSSO 58 th round estimated the age at onset of disability for the cohort of persons aged 60 years and above, who have acquired visual impairment (blindness or low vision). The data depicts that visual disability is an old age phenomena. It seems to start progressing at the age somewhere 45 years, as about 82-96 percent visually impaired persons acquired the impairment after the age of 45 years. About 62-72 percent visually impaired persons acquired it, after the age of 60 years. Significantly nearly 1-2 percent visually impaired persons had acquired visual impairment (blindness or low vision) since birth, probable due to heredity or malnutrition of pregnant mothers or due to inappropriate delivery services at the time of birth of a child. (Table No.II.5.8 and Figure No. II.5.4) Significantly 18.2%, 13.3% and 15.5 % males, females and both males and females together respectively were blind since birth. Similarly 12%, 6% and 8.7% males, females and both males and females had low vision since birth. Thus although males had higher prevalence rates of blindness and low vision at birth, yet the females outnumbered them in the later ages probably due to social, cultural, healthcare, educational and economic inequities. Table No. II.5.8 Visually Impaired Persons Age at Onset of Impairment for Cohort persons above 60 years Per 000' Impaired - 2002 Age Group Rural Since Birth 0-4 5-9 10-19 20-44 45-59 60+ Blindness Urban 19 7 9 11 50 220 684 Rural 13 9 5 20 37 294 621 Low Vision Urban 7 6 5 4 13 248 717 5 1 0 3 26 245 716 Source: NSSO Survey Round 47 th and 58 th in 1991 and 2002. Visually Impaired Persons, Degree of Impairment: There are several kinds of visual impairment of which the most common is blindness, which can occur due to various reasons such as malnutrition during childhood, illness, or due to accidents and during old age. Persons with visual impairment have a wide range of abilities as well as limitations. They may be able to read large print and may even move about without any mobility equipments in most situations or sometimes, they may be able to perceive light and darkness and perhaps even colours. The NSSO data of 2002 depicts that among the blind persons for rural areas 49% had no perception of light, while 20% had light perception but could not read while the rest 31% did not ever use specs, hence were visually impaired. In the case of urban areas 60% had no light perception, 25% had light perception but could not read while the rest 15 % have not used specs. Thus the non-usage of specs was higher in rural areas compared to the urban areas. In the case of low vision persons in rural areas, 16% cases have light perception but cannot read up to 3 meters distance even after using specs, while 34 % cases do not use specs and the rest 50% have low vision. In the case of urban areas 22% cases have light perception but cannot read up to 3 meters distance even after using specs, while 28 % cases do not use specs and the rest 50% have low vision. (Refer Table No. II.5.9 and Figure No. II.5. 5) Table No. II.5.9 Visually Impaired Persons Degree of Impairment per 100,000 persons 2002 Degree of Impairment Blindness Rural Urban No Light Perception 102 Light Perception but can not read 41 Does Not Use spec 67 Blindness (All three above) 210 Has Light Perception but can not count up to 3 meters distance (Uses specs) Does not use spec Low vision Rural 84 35 37 140 Low Vision Urban 27 24 59 86 172 30 54 108 Source: NSSO Survey Round 47 th and 58 th in 1991 and 2002. Visually Impaired Persons, Causes: Understanding of the causes of visual impairment is essential to prepare policy framework for their prevention, protection and rehabilitation. Among the common causes cataract, glaucoma, corneal ulcer, xerophthalmia and conjunctivitis have been found more profound in India . The major causes of childhood blindness among children in Asia are Vitamin A deficiency, congenital cataract/ Rubella and hereditary retinal diseases. Other disorders like; albinism, astigmatism, nystagmus, optic atrophy, retinitis pigmentosa and trachoma also cause visual impairment. Punani and Rawal has estimated that 81% of visually impaired cases are reported because of cataract, followed by 7% cases because of refractive errors, 3 % cases due to corneal opacity, 2% due to glaucoma, 0.20% because of trachoma, 0.04% for malnutrition and 6.76 % because of other reasons. NSSO survey 58 th round in 2002 has identified several causes for visual impairment (separately for blind and low vision persons). The common cause for visual impairment was found old age, cataract, eye disease, glaucoma, small pox, injury and burns, corneal opacity, medical surgical interventions and sore eyes in the first month after the birth. (Refer Table II.5.10 and Figure No. II.5.6) Table No. II.5.10 Visually Impaired Persons Cause of Impairment (per 000' Impaired Persons) 2002 Cause of Impairment Rural Sore eye during first month of life Sore eye after one month of life Severe diarrhea before age six years Cataract Blindness Urban 3 6 7 212 Rural 1 8 8 196 Low Vision Urban 1 2 5 280 1 4 7 358 Glaucoma Corneal Opacity Other eye disease Small pox Burns Injury other than burns Medical/ surgical intervention Old age Other Reasons Not Known 52 21 170 47 4 38 22 250 70 90 80 40 164 36 2 47 49 200 74 89 Source: NSSO Survey Round 47 th and 58 th in 1991 and 2002. The image cannot be display ed. Your computer may not hav e enough memory to open the image, or the image may hav e been corrupted. Restart your computer, and then open the file again. If the red x still appears, y ou may hav e to delete the image and then insert it again. Fig No II.5.4 The image cannot be display ed. Your computer may not hav e enough memory to open the image, or the image may hav e been corrupted. Restart your computer, and then open the file again. If the red x still appears, y ou may hav e to delete the image and then insert it again. Fig No II.5.5 32 48 109 10 3 44 17 295 34 110 40 14 163 9 3 58 28 198 52 59 The link ed image cannot be display ed. The file may hav e been mov ed, renamed, or deleted. Verify that the link points to the correct file and location. Fig No II.5.6 Prevention and Early Detection measures: The National Programme for Control of Blindness (NPCB) was launched in 1976 to bring down prevalence rate of blindness. Since its launch considerable progress has been made in building up infrastructure at macro, meso and micro levels in terms of developing of healthcare centres throughout the country. The major work under this programme has been the eradication of cataract through large-scale involvement of the voluntary and private sector. The WHO and a consortium on international non-governmental development organisations (INGDOs) have launched a massive scheme called Vision 2020, which states that the avoidable blindness in the developing countries must be prevented by the year 2020. The Danish International Development Agency (DANIDA) entered into bilateral agreement with the government of India in 1987 with the objective of preventing blindness. The combination of preventive and curative measures is essential to reduce the prevalence and incidence rates for visually impairment. The WHO- NPCB Survey of 198186 indicates that only 12% of the population of children with visual impairment are incurable. Allen Foster mentions that 90,000 children in India can be saved from Corneal Scar, if attention is paid at the appropriate time, similarly 30,000 children with congenital cataract and 500 children with Retinopathy of Ore-maturity (ROP) can be prevented if timely intervention is provided. Among the preventive measures Integrated Child Development Scheme (ICDS) is implemented through Anganwadi workers. The aim is to improve the nutritional intake and health status of children in the age group of 0-6 years. It also provides nutrition and health education for all women in the age group of 15-44 years. Specific programmes of early detection were initiated in the primary health centers with the help of voluntary and private organizations. These measures have helped to bring down the prevalence and incidence rates for visual impairments, which have been indicated by the NSSO survey of 2002. Visually Impaired Persons, Education Status Special education concept for disabled was being implemented as one of the alternatives to provide intensive care to severely handicapped persons. In most of these special schools the curriculum followed is similar to the one prescribed for non-disabled children for the same age group. However visual oriented concepts are exempted for visually impaired. Integrated education for disabled was considered as an alternative for costeffectiveness to have wider coverage for disabled children. Integration of children with visual impairment was considered helping in developing infrastructure and creating conducive education services for all. Hence the centrally sponsored scheme of integrated education was started in 1974. The scheme is being implemented in various states of the country. More than 50,000 children with impairments are benefited through this approach in around 15,000 schools. The education status of visually impaired (blind and low vision persons) depicted by the NSSO survey (2002) presents a bleak picture, in spite of the several centrally and state sponsored schemes for covering visual impaired children for education. Among the blind persons in rural areas 82.6% were illiterate, 11% were educated only up to primary level, 3.7% up to middle level, 1.4% up to secondary level and only 1 % above secondary level. In the case of urban areas 54.6% were illiterate, 25.7% were educated up to primary level, 7.6% up to middle level, 6.1% up to secondary level and 6% above secondary level. Thus gender bias towards women is found for education levels among the visually impaired. Even in the case of low vision persons the picture was similar as in the case blind persons. (Refer Table No. II.5.11 and Figure. No.II.5. 7) The education status of visually impaired persons indicates very poor response to the schemes specially meant for visually impaired. A significant proportion of visually impaired children are not enrolled in any schools. The gap is more pronounced between rural and urban areas. Integrated education programmes have not yielded the desired results as expected. Even the educational reservation as stipulated in the PWD Act of 1995 seems to be a non-starter. The role of voluntary sector and private sector needs to be emphasised, in order to majority of cover children with visual impairment. Higher education for the visually disabled is eluding, hence job reservations for the visually disabled are not fully utilized in the absence of qualified and skilled available disabled manpower. Table No.II.5.11 Visually Impaired Persons Education Status (per 000' Impaired ) Educational Status Rural Non-literate Primary Middle Secondary Higher-secondary Graduation and above Not Reported ALL Urban 826 113 37 14 6 3 1 1000 Blindness Rural 546 257 76 61 29 29 1 1000 Low Vision Urban 774 157 39 18 6 3 3 1000 576 235 73 63 21 30 2 1000 Although education of children with visual impairment is more than 100 years old, but the present service delivery systems is nowhere appropriate to cover even 25 to 30% of the children. Moreover majority of the children with visual impairment are dwelling in rural areas, which do not have the coverage of integrated, or special education. The concentration of special schools as well as integrated education programmes are located in the cities/ urban areas. Majority of the schools in villages do not have adequate number of disabled children to justify appointment of specialised trained teacher. Therefore the need of multi-category personnel is required. Inclusive education is required for meeting development of the capabilities of the general education system. Visual Impaired Persons, Work Activity Status: Equal opportunity for jobs to disabled persons was one of the major concerns of civil societies while pressurising government to adopt PWD-Act 1995. Special provision of 3% reservation of jobs in government sector has been envisaged in the Act- 1995 to provide job opportunities for the disabled. The social services for the disabled are non-existent, hence majority of the disabled are required to fend for themselves. Table No.II.5.12 Visually Impaired Persons Work Activity Status (Per 000' disabled) 2002 Source: NSSO Survey 58th round in 2002 Work Activity Status Rural Self Employed in Agriculture Self Employed in Non-Agriculture Regular Employee Casual Employee Unemployed Attending Education Institution Attending domestic work Begging Others ALL Blindness Urban 40 16 5 27 2 19 78 12 801 1000 Rural 50 11 30 12 4 128 76 13 676 1000 Low Vision Urban 84 37 5 69 3 37 149 7 610 1000 80 12 25 41 3 62 196 6 574 1000 The NSSO survey (2002) has reported a bleak picture of work status prevailing for the visually impaired persons in India . About 80% of blind persons in rural areas are without any source of income and those earning are employed in low profile jobs like; casual labourer, attending domestic services, begging etc; Only 4% blind persons are self employed in agriculture. In the case of urban areas 67.6% blind persons are without any source of income. Only 3% blind persons are regular employees and the rest are either casual workers or attending domestic chores. The low vision persons also depict similar situation except for the fact that a majority of economically active low vision persons are engaged in domestic chores compared to the blind persons in both rural and urban areas. (Refer Table No. II.5.12 and Figure No. II.5.8) Visual Impaired Persons, Work Activity Status Before and After Impairment: The work activity status before and after the impairment reported by the NSSO survey (2002) indicates that 56.7% blind persons were working in rural areas before the onset of disability. A significant proportion of them, 78.7% have lost the job because of the impairment, while 7% have changed jobs and only 14.3% are still working in the same job. In case of urban areas 42.4% blind persons were working before the onset of disability, but 71.3% of them have lost the job because of the impairment, while 8% have changed the jobs and the rest 20.7% are still working in the same job. In the case of low vision person comparatively higher proportion of the impaired persons are still working in the same jobs, but at the same time a significant proportion (61% in rural areas and 54.4% in urban areas) have lost the job because of the onset of the disability. Thus the disability has affected the economic status of the visually impaired persons in terms of loss of job as well as change of job. (Refer Table No.II.5.13 and Figure No. II.5.9) Appropriate measures need to be taken to counter the loss of job activity for the disabled persons through appropriate training, development of skill and providing employment opportunities in such skills. Since provision of job scenario in the government sector is shrinking, hence incentives need to be provided to the private sector to provide appropriate opportunities for economic activity to the visually impaired persons. New technologies have opened opportunities for visually impaired especially in software technology. The need of the hour is to provide appropriate specialised education service especially job oriented vocational training to the visually impaired persons . The image cannot be display ed. Your computer may not hav e enough memory to open the image, or the image may hav e been corrupted. Restart your computer, and then open the file again. If the red x still appears, y ou may hav e to delete the image and then insert it again. Fig No II.5.7 The image cannot be display ed. Your computer may not hav e enough memory to open the image, or the image may hav e been corrupted. Restart your computer, and then open the file again. If the red x still appears, y ou may hav e to delete the image and then insert it again. Fig No II.5.8 The image cannot be display ed. Your computer may not hav e enough memory to open the image, or the image may hav e been corrupted. Restart your computer, and then open the file again. If the red x still appears, y ou may hav e to delete the image and then insert it again. Fig No II.5.9 Table No.II.5.13 Visual Impaired Persons Work Activity Status, Before and After Disability,(Per 000' disabled) Work Status Blindness Low Vision Rural Before Disability $ After Disability Urban 567 787 Rural 424 713 Urban 634 610 455 544 Loss of Work 70 80 126 123 Change of Work 143 207 264 332 Same Work ALL 1000 1000 1000 1000 Source: NSSO Survey 58th round in 2002 Work Activity Status before disability per 1000 disabled PART II Speech Impaired Persons Magnitude, Composition and Characteristics Speech Impaired Persons: Person's inability to speak properly is considered his/her speech disability. Speech impairment refers to anyone of the following conditions: (a) Inappropriate sound in speech. (b) Stammering • Baby speech • Inability to learn correct sound and use incorrect speech • Incomprehensible speech Speech impairment refers if the person's speech was not understood by the listener, drew attention to the manner in which he/she spoke than to the meaning, and was aesthetically unpleasant. It also includes those whose speech is not understood due to defects in speech, such as stammering, nasal voice, hoarse voice and discordant voice and articulation defect. The NSSO 58 th round collected information on speech disability from all persons unlike in 47 th round, where it was collected only for the persons of age 5 years and above Speech Impaired Persons, Magnitude: According to the NSSO 58th round (2002) nearly 2.15 million persons constituting 11.65% of all the disabled population (18. 49 million) in India were having speech impairment. The reported speech impaired persons as per the NSSO survey have shown a marginal increase from 1.96 million in 1991 to 2.15 million in 2002. The marginal increase could be probably due to inclusion of below 5 years persons for enumeration in 2002 as compared to the enumeration of only persons 5 years and above in 1991. The proportion of speech-impaired persons to all disabled persons has however declined marginally from 12.17% in 1991 to 11.65% in 2002. Of the total speech-impaired persons nearly 40% were females and the rest 60% were males in 2002. (Refer Table No.II.6.1 and Figure II.6.1) Table No.II.6.1 Speech Impaired Persons Magnitude (in 000) Speech Disability Male Rural Urban Both 2002 Female 949 341 1291 Both 653 210 863 1991 Male 1602 551 2154 Female 942 298 1240 Source: NSSO Survey Round 47 th and 58 th in 1991 and 2002. Both 557 169 726 1499 467 1966 The image cannot be display ed. Your computer may not hav e enough memory to open the image, or the image may hav e been corrupted. Restart your computer, and then open the file again. If the red x still appears, y ou may hav e to delete the image and then insert it again. Fig No II.6.1 The image cannot be display ed. Your computer may not hav e enough memory to open the image, or the image may hav e been corrupted. Restart your computer, and then open the file again. If the red x still appears, y ou may hav e to delete the image and then insert it again. Speech Impaired Persons, Prevalence Rate: The prevalence rate (per 100,000 persons) for the speech-impaired persons in India has come down from 273 to 220 for rural areas and from 237 to 193 for urban areas during 1991- 2002. This indicates marginal improvement has taken place to prevent the disability through preventive and curative measures. The prevalence rates were higher among the males as compared to females both for rural and urban areas in 1991 and 2002. (Refer Table No. II.6.2 and Figure No. II.6.2) Table No. II.6.2 Speech Impaired Persons Prevalence Rate (per 100,000 persons) Speech Impairment Rural Male 2002 1991 Urban 254 Rural 228 Urban 333 285 Female 184 154 208 182 Persons 220 193 273 237 Source: NSSO Survey Round 47 th and 58 th in 1991 and 2002. Prevalence rate is number of disabled persons to 100,000 persons Speech Impaired Persons, Inter-state Prevalence Rate: The prevalence rate of speech-impaired males has depicted significant declining trends in majority of the states both in case of rural and urban areas during 1991 - 2002. In the case of rural areas significant decline in 2002 as compared to 1991 was recorded among males Karnataka, Andhra Pradesh, Tamil Nadu and Uttrancal. The prevalence rates among the speech impaired males in rural areas were lowest for Jammu and Kashmir, Punjab, Uttar Pradesh, Rajasthan, Madhya Pradesh, Bihar, Jharkhand, Maharastra Orissa and Assam Medium level prevalence rates were recorded in Tamil Nadu, Karnataka, Gujarat, Haryana, Chattisgarrh and West Bengal, while high prevalence rates were forKerala, Himachal Pradesh, Uttranchal, Mehgalaya and Arunachal Pradesh. In the case of urban areas speech impaired males recorded declining trends for prevalence rates in Andhra Pradesh, Tamil Nadu and Rajasthan. The prevalence rate among speech-impaired males was highest for Kerala, followed by Chattisgarh, West Bengal , Maharastra and Gujarat . All other states recorded uniform lower prevalence rates among males in urban areas. (Refer Map No. II.6.1 and Table No. II.6. 3) The prevalence rate for speech-impaired women for rural areas has also decreased significantly during 1991 to 2002 in Orissa, Karnataka, West Bengal and Tamil Nadu. Speech impaired women recorded lower prevalence rates among rural areas in majority of the states. However medium level prevalence rates were recorded in Tamil Nadu, Andhra Pradesh and Kerala. Sikkim recorded highest prevalence rate among women in rural areas for 2002. In the case of urban areas prevalence rates for women were uniformly lowest in all states. Sharp decline in prevalence rates for speech-impaired women was observed in Andhra Pradesh and Kerala in 2002 as compared to 1991. (Refer Map No. II.6.2 and Table No. II.6.4) Table No. II.6.3 India Speech Impaired persons Prevalence Rate (Per 100,000) Males STATES 1991 RURAL 2002 URBAN 1991 2002 A.P. Andaman & N. Isl. Arunachal Pradesh Assam Bihar Chandigarh Chhatisgarh D & N Haveli Daman & Diu Delhi Goa Gujraat H.P. Haryana J&K Jharkhand Karnataka Kerala Lakshadeep M.P. Maharashtra Manipur Meghalaya Mizoram Nagaland Orrisa Pondicherry Punjab Rajasthan Sikkim Tamil Nadu Tripura U.P. Uttaranchal West Bengal All India 403 334 323 211 208 668 424 517 287 327 288 286 274 399 291 358 333 311 352 384 165 227 299 269 149 175 30 75 276 360 278 228 242 257 419 447 201 240 119 375 113 144 206 244 187 181 873 256 140 211 392 275 242 426 288 300 282 103 232 280 401 241 244 297 282 297 407 226 259 285 Source: NSSO Survey Round Number 47 th and 58 th in 1991 and 2002 242 350 57 206 216 123 346 78 121 65 168 261 114 147 170 200 159 460 304 154 256 135 208 132 137 174 402 165 201 190 239 186 215 115 271 221 The image cannot be display ed. Your computer may not hav e enough memory to open the image, or the image may hav e been corrupted. Restart your computer, and then open the file again. If the red x still appears, y ou may hav e to delete the image and then insert it again. Table No. II.6.4 India Speech Impaired persons Prevalence Rate (Per 100,000) Females STATES 1991 A.P. Andaman & N. Isl. Arunachal Pradesh Assam Bihar Chandigarh Chhatisgarh D & N Haveli Daman & Diu Delhi Goa Gujraat H.P. Haryana J&K Jharkhand Karnataka Kerala Lakshadeep M.P. Maharashtra Manipur Meghalaya Mizoram Nagaland Orrisa Pondicherry Punjab Rajasthan Sikkim Tamil Nadu Tripura U.P. Uttaranchal West Bengal All India RURAL 2002 288 174 179 128 271 113 282 321 164 204 223 229 116 286 140 283 208 URBAN 1991 256 186 230 126 125 58 168 76 276 14 261 139 244 111 157 137 195 261 230 187 173 96 159 203 119 176 244 171 117 645 271 119 154 209 184 176 2002 291 81 130 136 122 160 177 255 115 206 248 243 141 203 127 194 182 Source: NSSO Survey Round Number 47 th and 58 th in 1991 and 2002 153 79 0 99 150 28 175 189 186 31 39 133 101 111 103 104 149 226 349 96 193 120 97 101 116 145 634 107 92 165 182 158 140 70 224 151 The image cannot be display ed. Your computer may not hav e enough memory to open the image, or the image may hav e been corrupted. Restart your computer, and then open the file again. If the red x still appears, y ou may hav e to delete the image and then insert it again. Speech Impaired Persons, Prevalence Rate- Age Groups: The prevalence rates of speech-impaired persons among the children below 4 years were 129 and 132 per 100,000 persons respectively for rural and urban areas. In the case of younger children and adolescent (5 to 24 years) it was hovering around 260 -300 for rural areas and 175-285 for urban areas. Thus prevalence rates among the rural areas were higher as compared to urban areas. The prevalence rates showed progressively declining trends both for rural and urban areas from the age of 25- 60 years. However the prevalence rate increased for the persons above 60 years of age both for rural and urban areas. Substantial decline in the prevalence rate was recorded during 1991-2002 for all age groups, including above 60 years ages. The decline was more pronounced in the case of urban areas. Thus age composition is closely associated with the prevalence rates of speech-impaired persons. Thereby indicating that preventive measures through proper diet, diagnosis improved healthcare are required. A significant decline in the prevalence rates of speech-impaired persons was observed in all the age groups especially for the older age groups (Above 60 years) during 1991 and 2002. Compared to the prevalence rate for all speech-impaired persons of 567 for rural areas and 339 for urban areas in 1991, it declined to 210 for rural areas and 187 for urban areas in 2002. (Refer Table No. II.6.5 and Figure No. II.6.3) Speech Impaired Persons, Incidence Rate: The incidence rate (reported cases of speech impaired persons per 100,000 persons during the last 365 preceding the NSSO survey in 2002) for the speech-impaired persons in India has come down from 5 to 3 both for rural and urban areas during 1991 2002. This indicates improvement has taken place to prevent the disability through preventive and curative measures. The incidence rate for males was 3 and 4 for rural and urban areas respectively while it was 2 both for males and females for rural and urban areas in 2002. Incidence rates have shown decline in 2002 for both gender groups in rural and urban areas as compared to 1991. (Refer Table No.II.6.6 and Figure No. II.6. 4) Speech Impaired Persons, Incidence Rate- Age Group: The incidence rates of speech-impaired persons up to age of 55 years were insignificant, hovering around 0-5 per 100,000 persons both among the rural and urban areas in 2002. However the incidence rates for the speech-impaired persons increased progressively from 55 years onwards and it was hovering around 5-15 for rural areas and 15-20 for urban areas for 55-60 ages groups. Age groups above 60 years registered incidence rate of around 20 both among rural and urban areas. Significantly urban areas reported higher incidence rates for ages 60 years and above. A significant decline in the incidence rates for the speech impaired was recorded from 1991 for all age groups, particularly for 60 years and above age groups, both in case of rural and urban areas. (Refer Table No.II.6.7 and Figure No. II.6. 5) Table No. II.6.5 Speech Impaired Persons Prevalence Rate -Age wise (per 100,000 persons) 1991- 2002 Age Group Rural 2002 Urban Rural 1991 Urban 0-4 5-9 10-14 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60+ 5 & Above 129 297 281 243 263 207 169 175 158 137 135 136 190 210 132 285 338 223 175 149 116 112 118 124 115 132 223 187 368 362 341 278 220 213 180 196 206 182 185 236 567 385 310 285 220 183 155 147 133 123 154 145 320 339 Source: NSSO Survey Round 47 th and 58 th in 1991 and 2002. Prevalence rate is number of disabled persons to 100,000 persons Table No. II.6.6 Speech Impaired Persons Incidence Rate (per 100,000 persons) Speech Impaired Rural Urban Male 3 2002 Rural 4 1991 Urban 6 5 Female 2 2 4 4 Persons 3 3 5 5 Source: NSSO Survey Round 47 th and 58 th in 1991 and 2002. Incidence rate is reported disabled persons during the last 365 days from the date of the survey per 100,000 persons. The image cannot be display ed. Your computer may not hav e enough memory to open the image, or the image may hav e been corrupted. Restart your computer, and then open the file again. If the red x still appears, y ou may hav e to delete the image and then insert it again. Fig No II.6.3 The image cannot be display ed. Your computer may not hav e enough memory to open the image, or the image may hav e been corrupted. Restart your computer, and then open the file again. If the red x still appears, y ou may hav e to delete the image and then insert it again. Fig No II.6.4 The image cannot be display ed. Your computer may not hav e enough memory to open the image, or the image may hav e been corrupted. Restart your computer, and then open the file again. If the red x still appears, y ou may hav e to delete the image and then insert it again. Fig No II.6.5 Table No.II.6.7 Speech Impaired Persons Incidence Rate Age Wise (Per 100,000 persons) Age Group Rural 0-4 5-9 10-14 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60+ 5 & Above 2002 Urban 2 0 2 0 1 4 0 2 1 3 3 5 15 3 Rural 4 1 0 1 1 3 0 1 2 0 13 16 19 3 1991 Urban 5 2 3 1 2 1 1 7 10 6 4 20 15 3 2 2 2 7 9 18 33 12 Source: NSSO Survey Round 47 th and 58 th in 1991 and 2002. Incidence rate is reported disabled persons during the last 365 days from the date of the survey per 100,000 persons. Speech Impaired Persons, Age at onset of Impairment: The NSSO 58 th round estimated the age at onset of impairment for the cohort of persons aged 60 years and above, who have acquired speech impairment. The data presented in the table below depicts that speech impairment is hereditary as well as old age phenomena, as a significant number of persons had acquired it since birth and at older ages. It seems to start progressing at the age somewhere 55 years, as about 45- 55 percent speech impaired persons acquire the disability after the age of 45 years in rural and urban areas respectively. About 35-45 percent speech impaired acquires it after the age of 60 years. Significantly nearly 30-37 percent persons have acquired speech impairment since birth. (Refer Table No.II.6.8 and Figure No II.6.6) Prevalence of speech disability from birth was also reported for all speech-impaired persons enumerated by the NSSO survey 2002. The data depicts that 80.7%, 82.7% and 81.5 % male, female and both male and females respectively were speech impaired from birth. This indicates that speech impairment is largely due to heredity or due to inappropriate delivery services at the time of birth of a child. Table No.II.6.8 Speech Impaired Persons Age at onset of disability for Cohort persons above 60 years Per 000' Impaired Age Group Rural Since Birth 0-4 5-9 10-19 20-44 45-59 60+ 2002 Urban 375 11 9 22 48 190 345 Rural 306 6 9 7 21 218 434 1991 Urban 42 23 24 47 262 594 35 39 9 57 287 572 Source: NSSO Survey Round 47 th and 58 th in 1991 and 2002. Speech Impaired Persons, Degree of Impairment: There are several kinds of speech impairment, as all speech impairments are not the same kind. The NSSO data of 2002 has identified speech impairment in terms of cannot speak, speaks only in single words, and speaks unintelligibly, stammers, speaks with abnormal voice and others. The data depicts that among the speech impaired persons 48.7 % cases could not speak, while 18.2% cases speak only in single words, 14% cases speak unintelligibly, 10.8% cases stammer, 5.7% cases speak with abnormal voice and the rest 2.5 % cases had other voice problems in the rural areas. In the case of urban areas 44.6 % cases could not speak, while 20.3 % cases speak only in single words, 15 % cases speak unintelligibly, 11.6 % cases stammer, 5.5% speak with abnormal voice and the rest 3 % had other voice problems. (Refer Table No. II.6.9 and Figure No. II. 6. 7) Table No.II.6.9 Speech Impaired Persons Degree of Impairment per 000 disabled Degree of Impairment Rural Cannot speak Speaks only in single words Speaks unintelligibly Stammers Speaks with abnormal voice Any Other 2002 Urban 487 182 140 108 57 25 Rural 446 203 150 116 55 30 1991 Urban 444 131 172 158 59 31 360 158 190 187 53 43 Source: NSSO Survey Round 47 th and 58 th in 1991 and 2002. Speech Impaired Persons, Causes: NSSO survey 58 th round in 2002 has identified several causes for speech impairment. The common cause for speech impairment was found paralysis, other illness, voice disorder, mental illness and mental retardation, injury other than burns, medical surgical interventions and other unknown reasons etc; In the case of rural areas paralysis, other illness and voice disorder was the major cause of speech impairment, while in the case of urban areas paralysis, other illness, mental illness and retardation and voice disorder were major causes of speech impairment. (Refer Table II.6.10 and Figure No II.6.8) Table NO.II.6.10 Speech Impaired Persons Causes (per 000' speech impaired persons) Cause of Impairment Rural Hearing Impairment Voice disorder Cleft Palate Paralysis Mental Illness/ Retardation Other Illness Burns Injury other than burns Medical/ surgical intervention Old age Other reasons Not known 2002 Urban 9 90 15 239 79 222 5 46 20 14 68 148 Rural 1 67 21 250 100 243 5 62 44 10 68 102 1991 Urban 36 90 26 191 91 221 4 32 15 22 72 200 32 63 14 240 90 207 6 47 29 23 81 168 Source: NSSO Survey Round 47 th and 58 th in 1991 and 2002. Speech Impaired Persons, Education Status The education status of speech impaired persons depicted by the NSSO survey (2002) presents pathetic picture. Among the speech impaired persons in rural areas 71.5% were illiterate, 21% were educated only up to primary level, 4.9 % up to middle level, 1.4 % up to secondary level and only 1 % above secondary level. In the case of urban areas 52.7 % were illiterate, 31.4 % were educated up to primary level, 8.4 % up to middle level, 3.8 % up to secondary level and 4% above secondary level. Marginal changes in the education status of the speech-impaired persons were registered during 1991-2002. The image cannot be display ed. Your computer may not hav e enough memory to open the image, or the image may hav e been corrupted. Restart your computer, and then open the file again. If the red x still appears, y ou may hav e to delete the image and then insert it again. Fig No II.6.6 The image cannot be display ed. Your computer may not hav e enough memory to open the image, or the image may hav e been corrupted. Restart your computer, and then open the file again. If the red x still appears, y ou may hav e to delete the image and then insert it again. Fig No II.6.7 The image cannot be display ed. Your computer may not hav e enough memory to open the image, or the image may hav e been corrupted. Restart your computer, and then open the file again. If the red x still appears, y ou may hav e to delete the image and then insert it again. Fig No II.6.8 The education status of speech impaired indicates poor response to the schemes specially meant for disabled. A significant proportion of speech-impaired children are not enrolled in any schools. The gap is more pronounced between rural and urban areas. Integrated education programmes have not yielded the desired results as expected. Even the educational reservation as stipulated in the PWD Act of 1995 seems to be a non-starter. The role of voluntary sector and private sector needs to be emphasised to in order to cover children with these impairments. Higher education for the speech impaired is eluding, hence job reservations for the speech impaired are not fully utilized in the absence of qualified and skilled available disabled manpower. (Refer Table No. II.6. 11 and Figure No. II.6. 9) Table No.II.6.11 Speech Impaired Persons Education Status (per 000' Speech Impaired Persons) Educational Status Rural Non-literate Primary Middle Secondary Higher-secondary Graduation and above Not Reported ALL 2002 Urban 715 210 49 14 6 5 1 1000 Rural 527 314 84 38 25 11 1 1000 1991 Urban 766 167 44 10 3 2 8 1000 Source: NSSO Survey Round 47 th and 58 th in 1991 and 2002. Speech Impaired Persons, Work Activity Status 579 282 72 28 13 16 10 1000 The NSSO survey (2002) has reported that 39.9 % of speech impaired persons in rural areas are without any source of income and among those working a significant proportion are employed in low profile jobs like; attending domestic chores, casual labourer, self employed in non-agriculture activities etc; Only 6.8 % speech impaired persons are self employed in agriculture, while 8.6 % were self employed in non-agricultural activities. In the case of urban areas 42 % speech-impaired persons are without any source of income. Only 4.9 % persons are regular employees and the rest are either casual workers or attending domestic chores or engaged in other low level jobs. Significantly the proportion of speech-impaired persons engaged in self-employed agricultural activities has declined in 2002 compared to 1991 in rural areas. Hence the PWD Act- 1995 has not improved the scenario for the disabled persons contrary to the expectation. Thus speech-impaired person who should have been easily employed as the nature of impairment may not effect a majority of activities in productive system. Unfortunately they are not provided with equal opportunities to earn their livelihood and are forced to be dependent. With specialised training and provision of loan facilities these impaired persons could be easily made a productive part of the economic system. Unfortunately very few efforts are made to give them equal opportunities. (Refer Table No.II.6.12 and Figure No. II.6. 10) Table No.II.6.12 Speech Impaired Persons Work Activity Status (Per 000' disabled) Work Activity Status Rural Urban Self Employed in Agriculture 68 Self Employed in Non-Agriculture 86 Regular Employee 10 Casual Employee 126 Unemployed 5 Attending Education Institution 164 Attending domestic work 140 Begging 2 Others 399 ALL 1000 2002 Rural 43 28 49 58 13 260 128 1 420 1000 1991 Urban 143 28 10 120 11 72 56 61 177 128 5 449 1000 183 127 2 488 1000 Source: NSSO Survey Round 47 th and 58 th in 1991 and 2002. Speech Impaired Persons, Work Activity Status Before and After Impairment: The work activity status of speech impaired persons before and after the impairment reported by the NSSO survey (2002) indicates that 10 % speech impaired persons were working before the onset of disability, but 21.9% of them have lost job because of the impairment, while 8.3% have changed jobs and 69.8 % are still working in the same job in rural areas. In the case of urban areas, 6.5 % were working before the onset of disability, but 33.4 % of them have lost the job because of disability, while 7.9 % have changed the jobs and the rest 58.6 % are still working in the same job. (Refer Table No.II.6.13 and Figure No. II.6. 11) Thus the disability has marginally affected the economic status of the visually impaired persons in terms of loss of job as well as change of job. Table No.II.6.13 Speech Impaired Persons Work Activity Status, before and After Disability, (Per 000' disabled) Work Status 2002 1991 Rural Before Disability $ After Disability Urban 100 219 Rural 65 334 Urban 79 464 88 599 Loss of Work 83 79 108 26 Change of Work 698 586 428 375 Same Work ALL 1000 1000 1000 1000 Source: NSSO Survey Round 47 th and 58 th in 1991 and 2002. Work Activity Status before disability per 1000 disabled The image cannot be display ed. Your computer may not hav e enough memory to open the image, or the image may hav e been corrupted. Restart your computer, and then open the file again. If the red x still appears, y ou may hav e to delete the image and then insert it again. Fig No II.6.9 The image cannot be display ed. Your computer may not hav e enough memory to open the image, or the image may hav e been corrupted. Restart your computer, and then open the file again. If the red x still appears, y ou may hav e to delete the image and then insert it again. Fig No II.6.10 The image cannot be display ed. Your computer may not hav e enough memory to open the image, or the image may hav e been corrupted. Restart your computer, and then open the file again. If the red x still appears, y ou may hav e to delete the image and then insert it again. Fig No II.6.11 PART II Mentally Impaired Persons Magnitude, Composition and Characteristics Mentally Impaired Persons: Mental impairment refers to a condition of arrested or incomplete development of mind of a person, which is specially, characterized by sub-normality of intelligence i.e. cognitive, language, motor or social abilities. Any mental disorder other than the mental retardation is mental illness. The NSSO survey (2002) categorised mental disability into mentally retarded and mentally ill persons. Mentally Retarded (MR): MR was considered those persons who: o Have difficulty in understanding instruction, who do not carry out his/ her activities like other of his/her age or exhibited behaviours like talking to self, o laughing/ crying, scaring, violence, fear and suspicion without reasons. Above conditions must be either since birth/ childhood, or before age of 18 years. Are late in talking, sitting, standing or walking. Mentally Ill (MI): MI were considered those persons who: o Have difficulty in understanding instruction, do not carry out his/ her activities like other of his/her age or exhibited behaviours like talking to self, laughing/ crying, scaring, violence, fear and suspicion without reasons. But at the same time did not possess these above conditions since birth/ childhood and before 18 years of age. Moreover they are not late in talking, sitting, standing or walking. Mentally Impaired Persons, Magnitude: Persons having mental retardation are prevalent in all societies and cultures. Several estimates have indicated that there are about 3% mentally retarded persons in the World. However 75% of them fall into mild mental retardation category, while the rest 25% having IQ (Intelligence Quotient) of below 50 are classified as moderately, severely or profoundly retarded. Nearly 10% of the people with mental retardation have associated medical conditions like Epilepsy, Hyperkinesis or mental illness. Nearly 4% of all children with mental retardation have multiple handicaps. According to the NSSO 58th round (2002) nearly 2.09 million persons constituting 11.33 % of all the disabled population (18. 49 million) in India were mentally impaired (both mentally retarded and mentally ill). About 5.37% cases were mentally retarded and 5.95% cases were mentally ill. According to the NSSO 58 th round (2002) about 994,000 persons were mentally retarded and 1.10 million persons were mentally ill. Of the total mentally impaired persons nearly 62 % were males and the rest 38 % were females in 2002. In the case of mentally retarded persons gender composition was 63% males and 37% females, while in the case of mentally ill the gender composition was 60% males and 40% females. Hence mental impairment was found more profound among males as compared to females both for MR and MI groups. (Refer Table No. II.7.1 and Figure. No. II.7.1) Table No.II.7.1 Mentally Impaired Persons Magnitude (in 000) 2002 Mental Impaired Type Male Mental retardation Mental illness Both Female 625 664 1289 Both Rural and Urban Areas Both 369 994 437 1101 806 2095 Source: NSSO Survey 58 th round in 2002 Mentally Impaired Persons, Prevalence Rate: The prevalence rates (per 100,000 persons) for the mentally retarded persons in India for 2002 were 92 and 100 respectively for rural and urban areas, while for mentally ill persons; it was 110 and 89 respectively for rural and urban areas. The prevalence rates were substantially higher among the males than among the females both for MR and MI groups in rural and urban areas. Urban areas recorded higher prevalence rates in the case of mentally retarded persons for both sexes, while on the other hand mental illness was more prevalent in rural areas for both the gender groups. (Refer Table No. II.7.2) Mentally Impaired Persons, Prevalence Rates Age Groups: The prevalence rates of MR were hovering around 59 and 75 for rural and urban areas respectively for the age groups of less than 4 years. MR prevalence rates depicted increasing trends from 5-19 years, which were around 150-175 and then it declined progressively for rest of the age groups. This picture was more or less similar in both the rural and urban areas. Thus MR is more prevalent among children and adolescent groups. Therefore specific educational programmes need to be developed to provide them appropriate education, so that they become the productive part of the economy in the later stages. On the other hand if appropriate educational services are not provided to them in the early stages, they will become dependent on the society. The overall prevalence rate for MR was 92 for rural areas and 100 for urban areas. MI prevalence rates were less (Less than 100) among children and adolescent groups, while the prevalence rates for rest of the age groups were hovering around 100-200. Prevalence rates were similar in adult and older age groups in the case of both rural and urban areas. MI phenomena a psychological problem is accentuated in the middle age groups due to several social, emotional, cultural, sudden traumatic and economic problems. Hence age groups do not show any significant relationships for MI. The overall prevalence rate for MI was 110 for rural areas and 89 for urban areas. (Refer Table No. II.7.3 anf Figure No. II.7. 2) Table No. II.7.2 Mentally Impaired Persons Prevalence Rate (per 100,000 persons) Mental Disability Type Rural MR Urban 113 2002 118 Male 69 81 Female 92 100 Persons MI 128 105 Male 91 71 Female 110 89 Persons Source: NSSO Survey Round 47 th and 58 th in 1991 and 2002. Table No. II.7.3 Mental Impairment Prevalence Rate (Age Groups) 2002 Age Group Rural 0-4 5-9 10-14 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60+ 5 & Above Mental Retardation Urban 59 115 148 172 141 105 91 64 39 23 23 17 11 92 Rural 75 153 165 164 137 87 86 93 46 50 25 12 7 100 Source: NSSO Survey 58 th in 2002. The image cannot be display ed. Your computer may not hav e enough memory to open the image, or the image may hav e been corrupted. Restart your computer, and then open the file again. If the red x still appears, y ou may hav e to delete the image and then insert it again. Fig No II.7.2 Mental Illness Urban 12 32 53 91 111 155 173 173 186 172 194 178 180 110 16 35 55 73 92 100 102 117 141 131 111 131 167 89 The image cannot be display ed. Your computer may not hav e enough memory to open the image, or the image may hav e been corrupted. Restart your computer, and then open the file again. If the red x still appears, y ou may hav e to delete the image and then insert it again. Fig. No. II.7.3 Mentally Retarded Persons, Inter-State Prevalence Rate: The prevalence rate of mentally retarded males for rural areas in 2002 was higher in Goa and Kerala followed by Punjab , Himachal Pradesh, Uttranchal and Jammu and Kashmir . Least prevalence rate was in Assam and Auranchal Pradesh, while Madhya Pradesh, Jharkhand and Andhra Pradesh recoded moderate level of prevalence rate. In the case of urban areas prevalent rate for mentally retarded males was high for Kerala and low for North East states and Bihar , Jharkhand, Rajsthan and Jammu and Kashmir . Other states recorded moderate to medium level prevalence rates for males in urban areas The prevalence rates for mentally retarded women in rural areas in 2002 were comparatively lower in all states. However Kerala, Tamil Nadyu and Manipur recoded high prevalence rates compared to other states. In the case of urban areas the prevalence rates for women for 2002 were low to moderate in all the states except for Kerala, Goa , Orissa and Maharastra. (Refer Map No.II.7.1 and Table No. II.7.4) Mentally Ill Persons, Inter-State Prevalence Rate: The prevalence rate of mentally ill males for rural areas in 2002 was higher in Arunachal Pradesh, Kerala, Himachal , Jammu and Kashmir , Goa and Kerala followed by Punjab , Himachal Pradesh, Uttranchal, West Bengal and Jammu and Kashmir . Least prevalence rate was in Andhra Pradesh, Karnataka and Chattisgarh. Other states recorded medium level of prevalence rates for mentally ill males in rural areas. In the case of urban areas the prevalence rate for mentally ill men were high for Kerala, West Bengal and Orissa. Low prevalence rate for mentally ill men were recorded in Arunachal Pradesh. Majority of the other states recorded medium to moderate prevalence rates for mentally ill men in urban areas. The prevalence rates for mentally retarded women in rural areas in 2002 were comparatively lower in all states. However Kerala and Orissa recorded high to medium level of prevalence rates. Least prevalence rates were recorded in Karnataka and Arunachal Pradesh. Other states registered moderate prevalence rates for mentally ill women in rural areas. In the case of urban areas the prevalence rates for mentally ill women in 2002 were low to moderate in all the states except for Kerala and Goa . (Refer Map No.II.7.2 and Table No. II.7.5) Table No. II.7.4 India Mentally Retarded Persons Prevalence Rate (Per 100,000 persons) 2002 STATES Male A.P. Andaman & N. Isl. Arunachal Pradesh Assam Bihar Chandigarh Chhatisgarh D & N Haveli Daman & Diu Delhi Goa Gujraat H.P. Haryana J&K Jharkhand Karnataka Kerala Lakshadeep M.P. Maharashtra Manipur Meghalaya Mizoram Nagaland Orrisa Pondicherry Punjab Rajasthan Sikkim RURAL Female 90 92 0 34 104 45 101 42 44 55 262 103 182 123 154 81 109 225 322 74 104 56 72 117 85 129 79 173 111 51 URBAN Male 85 78 25 58 36 43 58 89 51 7 119 75 65 61 67 39 92 141 173 53 80 47 45 151 40 71 59 67 57 29 Female 123 66 0 85 69 71 128 78 81 53 164 110 113 100 89 75 101 264 390 120 116 34 128 131 36 136 102 126 100 0 69 53 0 19 50 57 79 84 70 39 715 85 62 75 75 69 79 220 123 61 102 29 44 109 31 127 123 70 50 47 Tamil Nadu Tripura U.P. Uttaranchal West Bengal All India 122 28 123 163 140 113 Source: NSSO Survey 58 th in 2002. 105 15 55 51 85 69 140 31 123 114 136 118 86 40 71 52 88 81 The link ed image cannot be display ed. The file may hav e been mov ed, renamed, or deleted. Verify that the link points to the correct file and location. Table No. II.7.5 India Mentally Ill Persons Prevalence Rate (Per 100,000 persons) 2002 STATES Male A.P. Andaman & N. Isl. Arunachal Pradesh Assam Bihar Chandigarh Chhatisgarh D & N Haveli Daman & Diu Delhi Goa Gujraat H.P. Haryana J&K Jharkhand Karnataka Kerala Lakshadeep M.P. Maharashtra Manipur Meghalaya Mizoram Nagaland Orrisa Pondicherry Punjab Rajasthan Sikkim Tamil Nadu Tripura U.P. Uttaranchal West Bengal All India RURAL Female 70 203 369 136 145 90 64 84 13 50 108 126 294 105 216 111 54 281 169 105 108 133 133 179 60 182 69 101 104 173 101 42 122 157 224 128 Source: NSSO Survey 58 th in 2002. URBAN Male 78 308 11 74 62 0 130 55 42 32 66 102 126 77 137 60 49 275 195 93 92 101 130 138 70 168 14 81 64 95 82 31 72 48 112 91 Female 69 109 17 81 105 57 113 19 121 28 153 122 133 86 169 79 61 282 130 125 89 154 79 155 30 169 59 84 89 63 101 110 106 65 190 105 43 53 0 92 92 71 84 21 23 37 231 57 36 61 66 51 35 222 214 61 55 127 89 82 55 97 95 82 53 24 61 62 75 101 134 71 The image cannot be display ed. Your computer may not hav e enough memory to open the image, or the image may hav e been corrupted. Restart your computer, and then open the file again. If the red x still appears, y ou may hav e to delete the image and then insert it again. Mentally Impaired Persons, Incidence Rate: The incidence rates (reported cases of mentally impaired persons per 100,000 persons during the last 365 preceding the NSSO survey in 2002) were 1 and 3 respectively for MR and MI. Incidence rate for MR was 1 for both gender groups. However in the rural areas females have lesser incidence rates for MR. In the case of MI, males had incidence rate of 4, while it was 2 for females. Again female incidence rate for MI was less in the case of rural areas compared to the urban areas. (Refer Table No. II.7.6). Table No. II.7.6 Mental Impaired Persons Incidence Rate (per 100,000 persons) Mentally Impaired Rural MR Urban 1 2002 Rural +Urban 1 1 Male 0 1 1 Female 1 1 1 Persons MI 4 4 4 Male 2 3 2 Female 3 4 3 Persons Source: NSSO Survey Round 58 th in 2002. Incidence rate is reported disabled persons during the last 365 days from the date of the survey per 100,000 persons. Mentally Impaired Persons, Incidence Rate- Age Group: The incidence rates of MR among the children (up to 9 years) were insignificant, hovering around 1-2 per 100,000 persons both for the rural and urban areas. However the incidence rates for the age group of 15-19 years for urban areas depicted sudden increase and the incidence rate rose up to 4. For rest of the age groups incidence rates were insignificant. In the case of MI, the incidence rates depicted random distribution with higher incidence rates among the urban areas in the middle age groups (40-44 and above 60 years). In the case of rural areas the incidence rates were equally distributed in all age groups above 20 years. (Refer Table No.II.7.7 and Figure No. II.7.3) Table No.II.7.7 Mentally Impaired Persons Incidence Rate, Age Groups- 2002: Age Group Rural 0-4 5-9 10-14 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60+ 5 & Above Mental Retardation Urban 2 2 0 1 0 0 1 0 0 0 0 0 0 1 Rural 1 2 1 4 1 1 1 0 1 0 0 0 0 1 Mental Illness Urban 1 0 1 2 5 4 6 5 7 3 5 1 5 3 2 1 5 2 3 2 2 5 10 4 4 3 10 4 Source: NSSO Survey Round 58 th in 2002. Mentally Impaired Persons, Age Groups at Onset of Impairment The NSSO 58 th round estimated the age at onset of disability for the cohort of persons aged 60 years and above, who have acquired mental impairment (MR or MI). The data depicts that MR is an young age problem and probably inherited by birth or induced due to inappropriate delivery system at the time of birth of a child. 90% cases in rural areas and 71% cases in urban areas acquired MR since birth and another 7% and 8% acquired it, in the early age groups of 0-4 years in rural and urban areas respectively. Significantly 21% cases in urban areas also acquired it in 10-19 age groups. Prevalence of MR from since birth depicts that 83.4%, 85.1% and 84. % Male, female and both male and females respectively were MR cases since birth. Thus MR can be prevented if appropriate care is taken during pregnancy and at the time of delivery. MI on the other hand is reported to be heredity as well as middle age phenomena. About 5.3% cases in rural areas and 2.3% cases in urban areas acquired MI since birth, probably due to heredity or inappropriate delivery services at the time of birth of a child. However a significant proportion of MI cases have acquired MI in middle and later age groups. In the case of rural areas 41% cases acquired it in the ages between 45-59, while 28% cases acquired it after 60 years and 23% cases acquired it in mid ages of 20-40 years. In the case of urban areas 47% cases had acquired MI in the older age group of above 60 years. (Refer Table No.II.7.8 and Figure. No. II.7.4) Prevalence of MI from birth was also reported for all MI persons enumerated by the NSSO survey 2002. The data depicts that 22.8%, 23% and 22.9 % male, female and both male and females respectively were MI since birth. Table No. II.7.8 Mentally Impaired Persons Age at onset of Impairment for Cohort persons above 60 years Per 000' Impaired - 2002 Age Group Rural Since Birth 0-4 5-9 10-19 20-44 45-59 60+ Mental Retardation Urban 896 73 0 31 0 0 0 Mental Illness Rural 710 82 0 208 0 0 0 Urban 53 0 9 16 227 414 278 27 0 5 28 256 214 468 Source: NSSO Survey Round 58 th in 2002. Mentally Impaired Persons, Degree of Impairment: There are several kinds of degree of mental retardation cases. The NSSO data of 2002 has identified mental impairment in terms of late in sitting, walking, talking or having all the three together. The NSSO data depicts that among the MR persons in rural areas, 2.6% were late in sitting, while 2.1% were late in walking and 9% were late in talking but a significant proportion of cases (87%) were have these three problems altogether. Thus a significant proportion of MR persons were having multiple MR actions. In the case of urban areas the picture was again similar to rural areas with a significant proportion of cases 85.2% having multiple MR actions. (Refer Table No.II.7.9 and Figure No. II.7.5) Table No.II.7.9 Mentally Impaired Persons Degree of Impairment (per 100,000 persons) 2002 Degree of Impairment Rural Late in sitting Late in walking Late in talking All three above Mental Retardation Urban 26 21 90 863 Rural 19 26 103 852 Mental Illness Urban Source: NSSO Survey Round 58 th in 2002. A classification of mental retardation prepared by the Planning Commission classification. given in the Table No. II.7.9 below. It indicates clinical and educational Table No. II.7.9 Mental Retardation Classification (Degree of MR) is Clinical Educational IQ Classifica- Classific- Adult Focus of Education Level of Range Mental Age Training Achievement Adaptive As adults - Behavior Dependant Academic not For self care training Self care under supervision tion Profound ation Life Support <20 <3.08 - Severe Trainable 20-34 Years 3:09-6 Self Care years Skills Moderate Trainable 35-49 6:01-8:05 Self Care yrs Effective -Equivalent of IInd Independent or self care in Skills Mild Educable 50-69 8:06 yr 10:10 years Borderline Slow Learner 70-80 10-11 Practical Skills Vocational training Personal social skills Functional Education Academic skill years 13:03 years Vocational training IIIrd children grade IV-V grade level Independent self care in Can not handle money without -engage in semi supervision skilled or simple skilled jobs Some pass 10 th Achieve adequate standard through social and open school vocational adjustment - Capable of skilled and semi skilled jobs Mentally Impaired Persons, Causes: NSSO survey 58 th round in 2002 has identified several causes for mental retardation. The common cause for MR was found serious illness and head injury during childhood, inappropriate pregnancy and birth related services, heredity and other unknown reasons. 48% and 60% cases in rural and urban areas respectively reported serious illness or head injury during childhood as a major cause of MR. Around 3% cases each reported inappropriate pregnancy care or delivery related services and heredity as cause of MR. However 30-40% cases could not explain the reason of MR. MI cases also reported combination of causes, however a large proportion were unable to identify the cause as 75-80% cases were not knowing the actual cause of MI. Other cause for MI was serious illness or head injury during childhood, heredity and pregnancy and birth related cases. (Refer Table II.7.11 and Figure No. II.7.6) Table No.II.7.11 Mentally Impaired Persons Cause (per 000' Mentally Impaired persons) 2002 Cause of Disability Rural Pregnancy and birth related Serious illness during childhood Head injury during childhood Heredity Other reasons Not Known Mental Retardation Urban 29 393 85 20 201 250 Source: NSSO Survey Round 58 th in 2002. The image cannot be display ed. Your computer may not hav e enough memory to open the image, or the image may hav e been corrupted. Restart your computer, and then open the file again. If the red x still appears, y ou may hav e to delete the image and then insert it again. Fig No II.7.4 The image cannot be display ed. Your computer may not hav e enough memory to open the image, or the image may hav e been corrupted. Restart your computer, and then open the file again. If the red x still appears, y ou may hav e to delete the image and then insert it again. Fig. No. II.7.5 Rural 30 460 128 33 163 184 Mental Illness Urban 26 70 25 30 443 398 18 151 49 25 503 245 The image cannot be display ed. Your computer may not hav e enough memory to open the image, or the image may hav e been corrupted. Restart your computer, and then open the file again. If the red x still appears, y ou may hav e to delete the image and then insert it again. Fig No II.7.6 Prevention and Early Detection measures: The National Programme for MR was launched and the following measures were adopted: • Dissemination of available knowledge of ecology of MR through public media like newspapers, radio, television. • Improvement of prenatal and postnatal care through activating maternal and child health services. Some of the common preventive measures are: • Pregnant mothers should not exposed to X ray in the first trimester of pregnancy • The maternal age be restricted to 18-35 • Rh factor be controlled through blood transfusion • Compulsory testing of blood and urine after birth to take care of recessive gene disorder by appropriate dietary control. • Avoidance of consanguineous marriages • Complete immunization of pregnant mothers • Care during delivery • Optimal parental care against serious illness and head injury in infant stages. • Overcoming iodine deficiency. Mentally Impaired Persons: Education Status Special education concept for MR persons was being implemented as one of the alternatives to provide intensive care to severely handicapped persons. Even integrated education for MR (especially low IQ categories) after appropriate training in the special schools was considered as an alternative for cost-effectiveness to have wider coverage for MR children for education. Integration of children with other normal children was considered helping in developing infrastructure and creating conducive education services for all. The education status of mentally impaired (MR and MI persons) depicted by the NSSO survey (2002) presents very pathetic picture in spite of the several centrally and state sponsored schemes for covering mentally retarded children for education in special school. Several voluntary organizations have come forward to support education programmes for slow learners and Cerebral Palsy cases. In case of MR persons in rural areas 88.7% were illiterate, 9% were educated only up to primary level, 2% up to middle level and less than 1 % above middle level. Even in the case of urban areas 80.9 % were illiterate, 15% were educated up to primary level, 3.6% up to middle level, and less than 1% above middle level. Thus current education levels for MR are very poor and it requires special attention from voluntary, private and government sector. Experiences by several voluntary organizations have shown that with appropriate training and skill development a significant proportion of MR persons can be made economically active. In the case of MI 62% cases were illiterate, 20.8% educated up to primary level, 9.7% educated up to middle level and 8% cases had education up to secondary or above secondary levels in rural areas. However in the case urban areas MI persons depicts better educational levels as only 48.8% cases were illiterate, 23.7% were educated up to primary level, 12% were educated up to middle level and 16% had education up to secondary or above secondary levels. (Refer Table No II.7.12 and Table No. II.7.7) Table No.II.7.12 Mentally Impaired Persons Educational Status (per 000' disabled) 2002 Source: NSSO Survey 58th Educational Status Rural Non-literate Primary Middle Secondary Higher-secondary Graduation and above Not Reported ALL Mental Retardation Urban 887 90 20 2 1 0 0 1000 Rural 809 150 36 3 2 0 1 1000 Mental Illness Urban 620 208 97 35 26 10 2 1000 488 237 121 51 62 37 4 1000 The education status of MR indicates very poor response to the schemes specially meant for MR. A significant proportion of MR children are not enrolled in any schools. Even the educational reservation as stipulated in the PWD Act of 1995 seems to be a non-starter. The role of voluntary sector and private sector needs to be emphasised to in order to cover children with disabilities. Mentally Impaired Persons: Work Activity Status The NSSO survey (2002) has reported a dismal picture of work status prevailing for the MR persons in India . About 82% of MR persons in rural areas are without any source of income and are dependent on their families or other social organizations. Other MR persons employed are working in low profile jobs like; casual labourer, attending domestic services, begging etc; Only 4% MR persons are self employed either in agriculture or non-agricultural activities. In the case of urban areas 80% MR persons are without any source of income. Other MR persons are either casual workers or attending domestic chores. Only 2% MR persons are either self-employed ion non-agricultural activity or regular employees. In the case of MI, again significant proportions were unemployed both in rural and urban areas. Significantly 8% and 2% MI persons in rural and urban areas respectively were reported to be working as self employed in agricultural and non-agricultural activities. Another 7% MI persons were attending domestic chores. Probably these MI persons were mild MI cases working for others. (Refer Table No. II.7.13 and Figure. No. II.7.8) Table No.II.7.13 Mentally Impaired Persons Work Activity Status (Per 000' disabled) 2002 Work Activity Status Rural Self Employed in Agriculture Self Employed in Non-Agriculture Regular Employee Casual Employee Unemployed Attending Education Institution Attending domestic work Begging Others ALL Mental retardation Urban 12 28 2 22 0 70 43 2 821 1000 Rural 2 15 4 17 1 120 40 1 801 1000 Mental Illness Urban 40 35 6 61 1 25 84 4 743 1000 16 9 19 24 3 45 67 4 814 1000 Source: NSSO Survey 58th in 2002 Work Activity Status Before and After Impairment: The work activity status for MR and MI persons before and after the disability reported by the NSSO survey (2002) indicates that 4.6% MR persons were working before the onset of disability, but 60.1 % of them have lost job because of the disability, while 10.3% have changed jobs and only 19.3% are still working in the same job in rural areas. In the case of MR persons in urban areas, 2.1% were working before the onset of disability, but 71.6% of them have lost the job because of the disability, while 5.7% have changed the jobs and the rest 22.6% are still working in the same job. Among MI persons 53.3 % were working before the onset of disability. But after the MI 75.8% have lost the job, while 7.9 have changed the job and 16.4% continue to have same job in rural areas. In the case of urban areas 39.8% MI persons were reported to be working before the onset of MI. But after the onset of MI, 82.4% MI persons have lost the job, 6.1% have changed the job and 11.5% continue with same job after acquiring mental illness. (Refer Table No. II.7.14 and Figure No.II.7. 9) Thus the disability has affected the economic status of the mentally impaired persons in terms of loss of job as well as change of job. Table No. II.7.14 Mentally Impaired Persons Work Activity Status, before and After Disability, (Per 000' disabled) 2002 Work Status Mental Retardation Mental Illness Rural Before Disability After Disability Urban 46 601 Rural 21 716 Urban 533 758 398 824 Loss of Work 103 57 79 61 Change of Work 193 226 164 115 Same Work ALL 1000 1000 1000 1000 Source: NSSO Survey 58th in 2002 Work Activity Status before disability per 1000 disabled The image cannot be display ed. Your computer may not hav e enough memory to open the image, or the image may hav e been corrupted. Restart your computer, and then open the file again. If the red x still appears, y ou may hav e to delete the image and then insert it again. Fig No II.7.7 The image cannot be display ed. Your computer may not hav e enough memory to open the image, or the image may hav e been corrupted. Restart your computer, and then open the file again. If the red x still appears, y ou may hav e to delete the image and then insert it again. Fig No II.7.8 The image cannot be display ed. Your computer may not hav e enough memory to open the image, or the image may hav e been corrupted. Restart your computer, and then open the file again. If the red x still appears, y ou may hav e to delete the image and then insert it again. Fig. No. II.7.9 PART-3 Disabled Persons In India Government Disability Welfare Institutes: In consonance with the policy of providing a complete package of welfare services to disabled and handicapped individuals and groups, the Central government have set up national institutes along with their respective regional centres in each of the major area of disability. The thrust areas of these national institutes are development of manpower and of delivery models of services, which can have a widespread reach in the population. These institutes are: National Institute of Visually Handicapped (NIVH), National Institute of the Hearing Handicapped (NIHH), National Institute for Orthopaedically Handicapped (NIOH), National Institute for Mentally Handicapped (NIMH), The Institute for the Physically Handicapped (IPH) and National Institute of Research, Training and Rehabilitation (NIRTAR). These institutes run various specialized courses to train professional in the different areas of disabilities. The specialized courses include Masters / Bachelors/ Diploma for: - Physiotherapy - Occupational Therapy - Prosthetic and Orthotic Engineering - Special Education/ Vocational Training and Employment/(Mental Retardation) - Special Education in Hearing, Language and Speech, Audiology. - Speech Training Programmes and Orientation and Mobility Infrastructure for Visually Handicapped - Short-term training programmes for government and Non-governmental personnel. These Institutes also run Out Patient Departments (OPD) clinics, which include diagnostic, therapeutic and remedial services. They also provide educational, pre-school and vocational services. These institutes have started outreach programmes with multiprofessional rehabilitation services to the slums, tribal belts, foot hills, semi-urban and rural areas through community awareness programmes and community based rehabilitation facilities and services such as diagnostic, fitment and rehabilitation camps and distribution of aids and appliances to the disabled. Through outreach services, communities are sensitized on early-identification, prevention, intervention and rehabilitation of the disabled. Services such as vocational training and placement are provided in collaboration with NGOs. Technical know-how and information are also provided to NGOs, on infrastructure requirement for established service centers for the disabled. The image cannot be display ed. Your computer may not hav e enough memory to open the image, or the image may hav e been corrupted. Restart your computer, and then open the file again. If the red x still appears, y ou may hav e to delete the image and then insert it again. I. National Institute for the Visually Handicapped (NIVH):[1] The NIVH is located at Dehradun and was established in 1979 by upgrading the National Center for the Blind. It was registered as a Society in 1982 under the Societies Registration Act, 1860, under the administrative control of the Ministry of Social Justice & Empowerment, Government of India. The Institute has its regional center in Chennai to provide rehabilitation services in the southern states of the country. It renders vocational training at par with NIVH. It also provides rehabilitation services to the rural-based visually handicapped persons through its Community Based Rehabilitation (CBR) activities. The services of NIVH are extended to other areas through the Regional Chapter at Secunderabad and Kolkata (1977). In addition District Disability Rehabilitation Centers were established at Dharamshala, Haridwar, Almora, Tehri Garwal, Gaya and Sangrur under the aegis of NIVH. Major objectives of the Institute: To conduct, sponsor, coordinate or subsidize research in all aspects of the education and rehabilitation of the visually handicapped. To undertake, sponsor, coordinate or subsidize research in bio-medical engineering leading to the effective evaluation of aids or suitable surgical or medical procedure or the development of new aids. To undertake or sponsor the training or dedicated trainees teachers, employment officers, psychologists, vocational counsellors and such other personnel as may be deemed necessary by the institute for promoting the evaluation, training and rehabilitation of the visually handicapped. To distribute or promote subsidy in the manufacture of proto-types, and to manage distribution of any or all of the aids designed to promote any aspect of the education, rehabilitation or therapy of the visually handicapped. Programs: The programmes of the Institutes includes; Vocational Training, Manpower Development, Research and Development, Crisis Management including therapeutic assistance, placement and employment, production of reading material, manufacture of aids and appliances, and library and Information services. Education for the Visually Handicapped. The Institute conducts long-term as well as short term training programs for various professionals engaged in the service for the blind. The trainings conducted are: o o Training courses for secondary school teachers of the visually handicapped at its campus, the Blind Relief Association, New Delhi and the Blind Boy's Academy, Narendrapur, West Bengal. State Level Training Course for Primary School Teachers of the visually handicapped. The Institute, in collaboration with the concerned State Governments, is conducting training programmes for primary school teachers of the visually handicapped in Bhubaneswar (Orissa), in Hyderabad (Andhra Pradesh) and in Patna (Bihar). The Institute has a Model School for the visually handicapped, which provides education to blind, partially sighted and low-vision children from Nursery to Class X. The blind children are taught through Braille and tactile sensation whereas the partially sighted and low vision children make use of magnifying devices to read the printed text. The scholars are provided with free board, lodging, clothing, tuition and other facilities besides monthly pocket money. Services provided in the Institutes are: Workshop for the Manufacture of Braille Appliances: Various aids and appliances like Braille slate, Taylor Frame, Abacus, Stylus, Chess Board, Playing Cards, Pocket Frame, Folding Stick, Braille Scale, Geo Boards, Diagram Boards; Braille Shorthand Machine etc. are being manufactured. The Institute's Braille Press is producing reading material in Braille for the use of blind readers. Vocational Training: The Training Center for the Adult Blind persons imparts vocational training to the adult blind men and women between 18-40 years of age in a variety of vocational crafts like light engineering, weaving, candle making, chalk making, detergent powder making, stenography (Hindi and English), electronics and mechanical assembly, etc. Crisis Management: The Institute's Crisis Management Unit provides therapeutic assistance to persons who have been recently affected by loss of vision at their home and at the Institute. It also provides guidance and counseling to schoolchildren, trainees of training centers and to the parents of the visually handicapped. News Magazine: The Institute has recently started education programmes for visually handicapped students with additional disabilities. The Institute has also started to publish a Weekly News Magazine entitled "Braille Times" which provides news to its Braille readers. Publications: The Institute publishes a quarterly newsletter, Insight, which contains useful information about the activities of the Institute and of information relating to rehabilitation. Besides, the Institute has published a number of technical reports, books, brochures, and directories for the benefit of a wide range of professionals working in the field. National Library for the Print Handicapped: The Institute has a National Library for the print/visually handicapped. The Library offers free lending services to the visually handicapped readers all over the country. It has 45,948 Braille volumes and 7,761 print books. The library has a total membership of 2,980 persons. II.National Institute for the Hearing Handicapped (NIHH)[2]: The Ali Yavar Jung National Institute for the Hearing Handicapped (NIHH), Mumbai, was established on 9th August 1983 under the Societies Registration Act, 1860, as an autonomous body and under the administrative control of the Ministry of Social Justice & Empowerment. The Institute has its regional centers in Calcutta, New Delhi and Hyderabad and a State collaborated center in Bhubaneswar. In addition to this, the Institute also runs a training center for the adult deaf in Hyderabad. Major objectives of the Institute are: o o o o Development of manpower by undertaking or sponsoring the training of trainees and teachers, employment officers, psychologists, vocational counselors and such other personnel as may be deemed necessary by the institute for promoting the education, training or rehabilitation of the hearing handicapped. To conduct, sponsor, coordinate and subsidize research into all aspects of the education and rehabilitation of the hearing handicapped. To develop model services for rehabilitation of the hearing handicapped. To serve as an apex information and documentation center in the area of hearing handicapped. Programs: The programmes of the Institutes includes; Manpower Development like providing special educational degree/ diploma like; B.Ed (Deaf), B.Sc (Audiology and Speech Pathology and B.Sc., Hearing, Language and Speech, HLS), Diploma in Education of the Deaf, Diploma in Communication Disorders, B.Ed (Deaf) and B.Sc (Audiology and Speech Pathology) & B.Sc (HLS) are conducted in Mumbai and are affiliated to The University of Bombay; B.Ed (Deaf) is also being conducted at Eastern Regional Centres, Kolkata and B.Sc (Ed) & B.Sc (HLS) at Southern Regional Centre, Hyderabad with affiliation to Calcutta and Osmania Universities respectively. The Institute also conducts short term training programs to meet the demands of professionals and those in academics; unable to get admission for long-term training programs; or for those who could not get training and are already working in voluntary, non-governmental organizations and other institutions dealing with rehabilitation of the hearing and speech impaired. Research Programs The research work in the Institute is mainly community-based. Special projects aim at the rehabilitation of vast majority of handicapped located in semi-urban and rural areas. The Institute has already completed 7 research projects. Pre-schools The Institute has been conducting pre-school, parent guidance and counseling services and also parent-infant orientation/training programs, etc. The Institute also conducts diagnostic camps in different states and also conducts hearing aid camps for children in special schools. Several community-based programs are carried out to create awareness in the community regarding intervention, prevention and rehabilitation of the hearing impaired. Outreach and Extension Service Unit of the Institute has adopted various steps to reach the activities to the hearing impaired population in remote areas. Service Programmes The Institute has the latest audiological equipments such as audiometers and other sophisticated equipment to provide service facilities. The Institute has also developed a laboratory for this purpose. Services provided are: o o o o o o o o o Hearing evaluation Hearing aid trial, prescription, fitting and repairs Speech and Language therapy Speech and Language evaluation Parent guidance and counseling Psychological evaluation Psychotherapy, Behavior therapy and Play therapy Educational evaluation ENT, Pediatric and Neurological evaluation o o o Information services Vocational guidance, counselling and placement Outreach and Extension Service. Information and Documentation Center The Information and Documentation Center functions with the aim of acquiring relevant information for dissemination to organizations and individuals working for the hearing handicapped. The Information and Documentation Center is equipped with a computer unit, which facilitates software development, training of staff and students and data processing. III. National Institute for the Orthopaedically Handicapped (NIOH)[3]: NIOH was established in Kolkata in 1978. It was registered as an autonomous body in April 1982 under the Societies Registration Act, 1860. The main objectives of the Institute are to: To develop manpower for providing services to the orthopaedically handicapped population. This entails training of various personnel such as physiotherapists, occupational therapists, orthopedic and prosthetic technicians and employment and placement of officers & vocational counselors. To develop model services for the orthopaedically handicapped population in the areas such as restorative surgery, aids and appliances & vocational training. To provide services and special devices to the orthopaedically handicapped people. To conduct and sponsor research into all aspects related to the total rehabilitation of the orthopaedically handicapped. To standardize the aids and appliances for the orthopaedically handicapped and to promote their manufacture and distribution. To serve as the apex documentation orthopaedically handicapped. and information center in the area of To provide consultancy to the state governments and voluntary organizations working for rehabilitation of the orthopaedically handicapped. Programs: (a) Long Term Programme: o o o o (b) Bachelor of Physiotherapy (3 years and 6 months, capacity - 20). Bachelor of Occupational Therapy (3 years and 6 months, capacity - 20). Diploma in Prosthetic & Orthotic Engineering (2 years and 6 months, capacity 20). Bachelor in Prosthetic & Orthotic Engineering (3 years and 6 months, capacity 20). Short Term Programmes Every year 12-15 short courses are conducted for in-service, doctors, therapists, orthotists, prosthetics, social workers, psychologists, vocational counselors and nurses. These courses vary from 2 to 5 days and 20-25 professionals attend these programmes from NGOs and Government Organisations. These courses are provided free of cost. The Institute also conducts an 8-week course on Rehabilitation for doctors as a regular feature since 1994 along with a large number of awareness Programmes on Prevention of Disability. Services: Patients with locomotor/orthopaedic disabilities due to poliomyelitis, cerebral palsy, congenital deformities, leprosy, etc. and hearing handicapped are treated and rehabilitated. Patients requiring artificial limbs and other rehabilitation aids and appliances are provided with the same to prevent the impairment leading to disability and to make the patients near normal and to carry on their routine activities for daily living. The Institute has a 100-bedded hospital with all the latest gadgets and equipments for assessment and services related to restorative surgery, reconstructive surgery, microsurgery, speech therapy, physiotherapy and occupational therapy, orthotic and prosthetic, in-patient services, vocational counseling, diagnostic services, polio immunization, consultancy, library and information services for persons with locomotor disability for rehabilitation. The center has been holding rehabilitation camps in the tribal and interior districts of Orissa, Madhya Pradesh, Andhra Pradesh, Bihar, Jammu & Kashmir, etc; in order to strengthen the rehabilitation services for the handicapped. These camps (6 to 8 in a year) are arranged in collaboration with District Authorities and voluntary organizations. Research Activities The Institute has been introducing techniques in surgical corrections, treatment modalities, designing new and modifying the existing rehabilitation aids and appliances. Over the last few years several rehabilitation aids, including multipurpose orthotics for paralysed children, have been developed. The innovation of these rehabilitation aids has received the National Technology Award in 1993. IV. National Institute for the Mentally Handicapped (NIMH)[4] NIMH is located in Secunderabad, Andhra Pradesh. It was registered in 1984 under the Societies Registration Act, 1860 as an autonomous body under the Ministry of Social Justice & Empowerment, Government of India. Regional Centres of NIMH are located at Mumbai, Kolkata and New Delhi. These institutes are committed to develop models of care for persons with mentally impaired. NIMH conducts research in the area of mental handicap, promotes human resource development and work with mentally handicapped persons in the country. Major objective of the centre are: o o o o o o o Develop appropriate models of care and rehabilitation for the mentally retarded persons appropriate to Indian conditions. Develop manpower for delivery of services to the mentally handicapped. Identify, conduct and coordinate research in the area of mentally handicapped. Provide consultancy services to voluntary organizations in the area of mentally handicapped and to assist them wherever necessary. Serve as a documentation and information center in the area of mental retardation. Acquire relevant data to assess the magnitude/causes, rural-urban composition, socio-economic factors, etc. of mental retardation in the country. Promote and stimulate growth of various kinds of quality sources in the country for persons with mental retardation throughout the country. Programs The Institutes undertakes Degree/ Diploma courses in Mental Retardation, Vocational Training and Employment. In addition four courses are conducted every year during the summer at headquarters and its regional centers at Delhi, Kolkata and Mumbai. These courses are attended by professionals who are given update on recent developments with the objective to enhance their knowledge and skill training and special education, assessment and intervention in language / communication aspects, development and implementation of individualized educational program as also techniques of classroom management and early intervention programs. Major programmes relate to developing human resource development. The Institute covering the areas of special education, medical aspects, behavior modification, urban and rural services, vocational training, speech and language training programs also conducts short-term courses. The following are a few short-term courses conducted at the Institute: Workshop on basic Mental Retardation Orientation Camp on Special Olympics Workshop for Special educators Orientation program for multi-purpose health workers Training program for Speech pathologists Training Program for ICDS/Anganwadi Workers Workshop on Behavior modification Workshop for Psychologists Parent Training Programs V. The Institute for the Physically Handicapped (IPH)[5]. The Institute for the Physically Handicapped (IPH), located in New Delhi, was set up on 12th November 1976 under the Societies Registration Act, 1860. The main aims and objectives of the Institute are to develop manpower in the field of rehabilitation and also to serve the orthopaedically handicapped of all age groups. Major objectives of the Institute are: To offer education, training, work-adjustment and such other rehabilitation services as the society may deem fit to orthopaedically disabled persons with associated mental retardation. To undertake the training of Physiotherapists, occupational therapists and such other personnel needed for manning services for the disabled persons. To undertake the manufacturing and distribution of such aids and appliances as are needed for the education, training and rehabilitation of the disabled persons. To provide such other services as may be considered appropriate for promoting the education and rehabilitation of the disabled persons, including organizing meetings, seminars and symposia. To undertake, initiate sponsor or stimulate research aimed at developing more effective techniques for the education and rehabilitation of the disabled persons. To undertake or sponsor such publications as may be considered appropriate. To co-operate with the national, regional or local agencies in search or such other activities as may be designed to promote the development of the services for the disabled persons. To do such other/activities as may be necessary or incidental to the realization of the above objectives. Programs: To achieve the main objective of the manpower development in the field of rehabilitation, the Institution conducts B.Sc (Hons) and Diploma Course in Physical Therapy and Occupational Therapy of 4-1/2 years duration and one years duration each. The courses are affiliated to the University of Delhi. The Institute has facilities of library to cater the academic needs of the students. Institute also provides the separate hostel for boys and girls situated in the premises of the Institute. Services: Institute provides the care and clinical treatment to the outpatients in physical therapy with modern electrotherapy and exercise therapy equipment. The disability covered for treatment is paraplegia, hemiplegia, arthritis, cerebral palsy, post polio residual paralysis, congenital anomalies, etc; Occupational therapy outpatient department also provides treatment & rehabilitation to the persons with neurological and skeletal disorders etc. The Institute established a speech therapy unit in May 1988 with the objective of providing services to persons affected with speech and hearing disorders including all age groups. The Speech therapy OPD has equipment for the examination and treatment of patients with hearing and speech disorders. One of the most important activities of the Institute is to provide Prosthetic and Orthotic appliances. In the Workshop artificial limbs, aids and appliances are fabricated and assembled for fitting according to the individual and specific needs of patients suffering from disabilities of Neuro-musculo-skeletal origin. It also has tailoring, carpentry and painting sections. In the workshop the students studying for the Diploma in Prosthetic & Orthotic Engineering are provided with practical training on learning skills of Prosthetic and Orthotic Engineering Technology. The workshop is providing these appliances to the needy people at very reasonable prices. The important feature of this is that the appliances are manufactured keeping the Indian environment in mind. The Institute is an implementing agency for the scheme of Assistance to the Disabled persons sponsored by the Ministry of Social Justice & Empowerment. In the year 1994-95 the institute supplied aids and appliances worth Rs 62.83 lakhs to 2997 beneficiaries. Special Education School The institute is running a special school since 1978 to impart education to mild to moderate Orthopeadically disabled children up to primary level. The children are provided with textbooks and uniform free of cost. Nominal charges are charged for transportation to and fro from their residences. The aim of the Special School is to provide education and physical rehabilitation facilities, simultaneously. The Institute has a library to meet the requirements of students, staff and guest faculty. There are 6616 books on various medical and professional subjects. The institute has a medium sized printing press to cater to the printing and binding needs of the Ministry of Social Justice & Empowerment and other Govt. Departments. VI. National Institute of Rehabilitation Training & Research (NIRTAR)[6]. NIRTAR is located at Olatpur, 35 kms from Bhubaneswar/Cuttack It has been established since 1975 as an adjunct Unit of Artificial Limbs Manufacturing Corporation (ALIMCO), Kanpur. NIRTAR was registered in 1984 under Societies Registration Act 1860 under the administrative control of the Ministry of Welfare, Government of India. The main aims and objective of the Institute are to To promote the use of products made by Artificial Limbs Manufacturing Corporation of India. To sponsor or coordinate the training of various personnel such as doctors, engineers, prosthetics, orthotic, physiotherapists, occupational therapists & multi-purpose rehabilitation therapists. To conduct, sponsor, coordinate or subsidize research in bio-medical engineering leading to an effective evaluation or development of mobility aids or any suitable treatment related procedure. To promote, distribute or subsidies the manufacture of prototype aids. To develop models of delivery of services. To undertake vocational training, placement and rehabilitation of the physically handicapped. To document and disseminate information on rehabilitation in India and abroad. VII. Rehabilitation Council of India (RCI)[7] The Rehabilitation Council of India was set up as a registered society in 1986. The Parliament enacted Rehabilitation Council of India Act in 1992. The Rehabilitation Council of India is a Statutory Body. It also prescribes that any one delivering services to people with disability, who does not possess qualifications recognised by the RCI, could be prosecuted. Thus the Council has the twin responsibility of standardizing and regulating the training of personnel and professional in the field of Rehabilitation and Special Education. It also undertakes research programme, training programmes and other dissemination and referral services for disabled persons. Other Support Services for Disabled: Government of India has developed several national, regional and district levels support centers to provide effective services to meet their requirements for aids and appliances, education, training and employments and other appropriate rehabilitation services. These macro, meso and micro level centres are located throughout the country to provide services at macro, meso and micro regional levels. The centers are: Artificial Limb Manufacturing Corporation of India (ALIMCO) Indian Spinal Injury Center (ISIC) National Information Center on Disability and Rehabilitation (NICDR) Composite Regional Centers (CRCs) Regional Rehabilitation Training Centers ( RRTCs) Vocational Rehabilitation Centers (VRCs) District Rehabilitation Centers ( DRCs) The image cannot be display ed. Your computer may not hav e enough memory to open the image, or the image may hav e been corrupted. Restart your computer, and then open the file again. If the red x still appears, y ou may hav e to delete the image and then insert it again. A. Artificial Limbs Manufacturing Corporation of India, Kanpur[8]: (ALIMCO) ALIMCO is a non-profit making organization, working under the aegis of Government of India. It was incorporated in 1972 to take up manufacture and supply of artificial limb components and rehabilitation aids for the benefit of the physically handicapped and started production in 1976. The main objectives of the Corporation are: 1. To promote, encourage and develop the availability, use, supply and distribution of artificial limbs & accessories and constituents thereof, to needy persons particularly disabled defence personnel, hospitals and such other welfare institutions, at reasonable cost in the country. 2. To establish facilities for manufacturing of artificial limbs & accessories and constituents thereof needed by the disabled persons in the prefabricated modular form and all other things which can be or may conveniently be used for the manufacture of or in connection with such articles, things as aforesaid. 3. To carry on the business of manufacturers, sellers, importers, exporters, dealers in and of artificial limbs & accessories and constituents thereof and all other things which can be or may conveniently be used for the manufacture of or in connection with such articles, things as aforesaid. B. INDIAN SPINAL INJURY CENTRE, NEW DELHI: (ISIC) ISIC, New Delhi has been developed under the Indo-Italian Development Programme to provide comprehensive treatment, rehabilitation services, vocational training and guidance to spinal injury patients. It is the only Center of its kind in Asia. Facilities include Spine surgery, Neurology, Neuro Surgery, Orthopaedic Surgery, Plastic Surgery, Urology, Sexuality, Clinical Psychology & Peer Counselling, Dental Services & Faciamaxillary Surgery. This has been set up to provide comprehensive treatment, rehabilitation services and vocational training and guidance to patients with spinal injury. Poor and indigent patients with various types of spinal injuries and problems get free services in the centre. The Center also conducts research in multidimensional aspects of rehabilitation of such patients. For joint funding of research component of Indian Spinal Injury Center, a Memorandum of Understanding (MOU) was signed by NIDRR and Ministry of Social Justice and Empowerment. Assistance through Overseas Development Administration, UK on Urban Based Community Rehabilitation under Overseas Development Administration of the United Kingdom (ODA), Urban Community Based Rehabilitation Program has been taken up in the cities of Kolkata, Bangalore and Vishakapatnam. Four Regional Rehabilitation Centres (RRCs) for persons with spinal injuries and orthopedic disabilities are being set up as a Central Sponsored Scheme with Centre and State share on 90:10 basis to strengthen the services. These Centres are to be located at Jabalpur (MP), Mohali (Punjab), Orissa and Bareily (UP). Services to be provided by these centres include diagnostic facilities, equipped Physio-Occupational therapy and artificial limbs and appliances fitting centre among other things. C. NATIONAL INFORMATION CENTRE ON DISABILITY AND REHABILITATION [9](NIDRR) The Government of India, with the assistance of the National Institute of Disability, Research and Rehabilitation, (NIDRR), a United States Government organisation, has set up the National Information Center on Disability and Rehabilitation in Delhi, an apex centre on information relating to various aspects of disability. The national centre has undertaken work of collection, classification and storage of data on twelve different aspects of disability. The Center has the responsibility to undertake gathering, updating and disseminating information on the following: The activities of NICDR include: Organizing Public Relation Activities e.g. seminars, exhibitions, workshops in different regions for facilitation of services, motivation and prevention awareness creation. Providing information to disabled persons regarding concessions, facilities and other rehabilitation programmes for their benefit. Preparation and publication of following journals/booklets - Indian Journal on Disability and Rehabilitation (IJDR) - Programmes and concessions to the disabled persons through the central government. - Concessions & facilities provided to the disabled by the state/U.T. governments. - NGOs receiving Empowerment. grant under various schemes of Ministry of Social Justice & - Organizations & Institutions working for the disabled. D. Composite Regional Centres (CRCs) for Persons with Disability[10]: Five Composite Regional Centres (CRCs) for disabilities are approved for being set up in different parts of the country. An outlay of Rs.16.89 crore has been approved for the Centres. The Centres have started functioning at Srinagar and Lucknow 2000-2001. Centres at Sundar Nagar (Himachal Pradesh), Bangalore and Guwahati are being set up. The basic objective of setting up Composite Resource Centres (CRCs) is to create the infrastructure required for training and manpower development, research and providing services to persons with disabilities, particularly in those parts of the country where such infrastructure is lacking at present. The proposed centers would also serve as Resource Centre for rehabilitation and special education of persons with disabilities and develop strategies for delivery of rehabilitation services suitable to the socio-cultural background of the region. These Centres will also undertake designing, fabrication and fitment of aids and appliances. E. Regional Rehabilitation Training Centers (RRTCs) Four RRTCs have been functioning under the DRC Scheme at Mumbai, Chennai, Cuttack and Lucknow since 1985. These RRTCs are providing training to village level functionaries, DRC professionals and orientation and training of State Government officials. These centers also conduct research in service delivery and manufacturing of low cost aids, etc. Apart from developing training material and manuals for actual field use, RRTCs also produce material for creating community awareness through the medium of folders, posters, audio-visuals, films and traditional forms. F. Vocational Rehabilitation Centers (VRCs): Economic rehabilitation of the disabled is an important component. The Ministry of Labour through the Directorate General of Employment &Training (DGET) extends its services to persons with disabilities through 17 Vocational Rehabilitation Centers (Including 7 skill development centers) for the handicapped located in 16 states covering all types of disabilities. The disabled are provided free training and stipend, during the training period. In addition 3% seats in the Industrial Training Institutes are reserved for the persons with disabilities. The VRCs are located at Ahmadabad, Mumbai, Bangalore, Kolkata, New Delhi, Jaipur, Hyderabad, Jabalpur, Kanpur, Ludhiana, Chennai, Guwahati, Trivendrum, Bhubaneswar, Baroda, Patna and Agartala. VRC Baroda is exclusively for women disabled. The following table depicts clients handled by the VRCs throughout the country during 2000- 2001 as well as cases handled since inception of the scheme. It depicts that 32% cases of the total evaluated were rehabilitated by the VRCs. A total of 423,411 cases were evaluated by the VRCs throughout the country and out of those cases, 133,859 disabled cases have been rehabilitated after providing appropriate vocational training to the disabled. A significant proportion of them were locomotor disabled followed by hearing and visually impaired. However a significant number of cases have left the training without completing it, which is a cause for worry and it requires further follow up. Table No. III.1.1 Rehabilitation of Persons with Disabilities Performance by VRCs 2000-2001 Particulars Number of Clients admitted VH 2173 1-4-2000 to 31-3-01 Number of Clients admitted 37019 since inception till 31-3-2001 Clients Evaluated 2149 HH 2933 LM 28936 CL 119 MMR 601 ALL 34762 38088 355651 3450 4948 439156 2877 28640 112 609 34387 1-4-00` to 31-3-01 Clients evaluated since inception till 31-3-2001 33573 35333 345461 4237 4807 423411 Left without completing 34 29 264 1 11 339 1-4-00 to 31-3-01 Left without completing 1319 1588 12656 83 152 15798 Since inception to 31-3-01 Clients rehabilitated 521 1050 7811 28 223 9633 1-4-00 to31-3-01 Clients rehabilitated 12352 14062 105232 949 1264 133859 Since inception to31-3-01 % Clients rehabilitated to evaluated 24.2 36.5 27.3 25.1 36.3 28.1 1-4-00 to31-3-01 % Clients rehabilitated to evaluated 36.8 39.8 30.5 22.4 26.3 31.6 Since inception to 31-3-01 VH: Visually Handicapped, HH: Hearing Handicapped, LM: Locomotor Disabled, CL: Cured Leprosy, MMR: Mild Mentally Retarded. Source: Annual Report 2001-02, Office of the Chief Commissioner for Persons with Disabilities, New Delhi. G. District Rehabilitation Centres (DRCs) The District Rehabilitation Center scheme was launched in early 1985 to provide comprehensive rehabilitation services to the rural disabled in the rural and urban areas at their doorsteps. This was done in collaboration with the National Institute of Disability and Rehabilitation Research (NIDRR), Washington, U.S.A. A Central Administrative and Coordination Unit (CACU) for coordinating and administering the activities of DRC were set up. The aims and objectives of the DRCs include survey of disabled population, prevention, early detection and medical intervention and surgical correction, fitting of artificial aids and appliances, therapeutic services - physiotherapy, occupational therapy and speech therapy, provision of educational services in special and integrated schools, provision of vocational training, job placement in local industries and trades, creation of self-employment opportunities, awareness generation for the involvement of community and family to create a cadre of multi-disciplinary professionals to take care of major categories of disabled in the district. There are at present 11 DRCs in 10 States. The DRCs are located at Bhubaneswar Kharagpur, Chengalpattu, Mysore, Sitapur, Virar, Kota, Bilaspur, Vijayawada, Bhiwani and Jagdishpur[11]. The experience and feedback gathered and received from the DRCs has encouraged developing Districts Rehabilitation Disability Centres (DDRCs) for initiating rehabilitation services throughout the country for support and rehabilitation of persons with disabilities. 107 districts have been identified which will be provided core rehabilitation services and also facilitate convergence with other developmental programmes. About 57 DDRCs have already become functional. 28 district centres are already operational and are directly supported either by National Institutes/ Apex Institutes/ and existing DRCs for disability. These 28-district centres are at Koraput, Philibit, South Dinapur, Dharamshala, Vardha, Gulburga, Gwalior, Tuticorn, Udaipur, Patiala, Anantpur, Madrai, Patiala, Chengapattu, Kozikode, Tiruvananthapuram, Almora, Jabhua, Pondicherry, Vellor, Mangalore Salem, Virudhnagar, Dimapur, Vishakhapatnam, Krishna, Gantok and Jalpaiguri. The performance of the District Rehabilitation Centers ( DRCs ) is given in the following table. It indicates that in addition to providing training and educational facilities to the disabled, these centers have also registered cases for therapy and have conducted surgical corrections to disabled. A significant number of disabled have been provided with Aids and Appliances by these DRCs. Training programmes by the RRTCs have benefited around 15030 disabled through these DRCs[12]. Table No.III.1.2 Performance of District Rehabilitation Centers 1997- 2000 Particulars 1997-98 Number of Assessment Clinics Conducted 1532 Number of Disabled Evaluated 22178 Cases Registered for Therapy 12625 Surgical Corrections Done 1133 Aids and Appliances Supplied 6493 Social Rehabilitation Programmes 2341 Conducted Clients provided education Services 4960 Vocational Training Job Placement 608 1998-99 1506 21858 11660 452 5067 2610 1999-2000 1945 22500 15212 567 5229 3836 All 4983 66536 39497 2152 16789 8787 1954 1110 4317 1010 11231 2728 Follow Up Clinics Conducted 573 Cases Evaluated in Follow Up Clinics 8332 Disabled provided with Pensions 1930 Disabled Provided with Bus Passes 2416 Provided Other Benefits 1056 Training Programme conducted by RRTCs 189 Beneficiaries through these RRTCs 6627 Programmes 1351 11937 881 4561 2819 140 3419 495 14259 1314 3598 1678 213 4984 2419 34528 4125 10575 5553 542 15030 Source: Annual Report 2000-2001, Ministry of Social Justice and Empowerment, Government of India. Support to NGOs: In order to penetrate and provide rehabilitation services throughout the country, the Government also runs schemes to assist NGOs for taking up programmes of providing services for persons with disabilities. One of the important schemes is the scheme for Assistance to Disabled Persons for Purchase/Fitting of Aids & Appliances. The main objective of the scheme is to assist the needy disabled persons in procuring durable, sophisticated and scientifically manufactured modern standard aids and appliances which can promote their physical, social and psychological rehabilitation. Assistance to Voluntary Organizations / NGOs for Disabled: The Ministry of Social Justice and Empowerment, Government of India has been actively promoting and strengthening voluntary action for welfare of persons with disabilities in the country. The main objective of the policy of the Ministry is to promote services for people with disability through non-government organizations so that persons with disability are encouraged to become functionally independent and productive members of the nation through opportunities of education, vocational training, medical rehabilitation, and socio-economic rehabilitation. Emphasis is also placed on coordination of services particularly those related to health, nutrition, education, science and technology, employment, sports, cultural, art and craft and welfare programs of various government and non-government organizations. Several schemes were started with a view to provide assistance to voluntary organizations working in the field of handicapped welfare. It is a comprehensive scheme to cover different areas of support and rehabilitation - physical, psychological, social and economic. Financial support is given up to the extent of 90 per cent of the total project cost (up to 95 per cent for the rural areas), for recurring items like staff salary, maintenance charges, contingencies and non-recurring items like construction of the building. Two broad schemes have been developed under this programme. Providing financial assistance for aids/appliances to persons with disabilities and Providing financial assistance to NGOs for providing educational, vocational and social rehabilitation programmes. Rupees 500,000 or more financial assistance is given for such projects as vocational training centers, special schools, counseling centers, hostels, training centers for personnel, placement services, etc. I. Assistance to Disabled Persons for Purchase/ fitting of Aids and Appliances (ADIP). The Ministry of Social Justice and Empowerment aims at helping the disabled persons by bringing suitable, durable, scientifically- manufactured, modern, standard aids and appliances within their reach through a scheme of Assistance to Disabled Persons for Purchase/ Fitting of Aids & Appliances (ADIP). The main objective of the scheme is to assist needy physically handicapped persons in procuring durable, sophisticated and scientifically manufactured aids and appliances that promote their physical, social and psychological rehabilitation. The scheme is implemented through centers run by the companies registered under Companies Act, registered societies, trusts or any other institutions recognized by the Ministry of Social Justice & Empowerment for the purpose. A large number of governmental and non-governmental agencies are engaged for the implementation of the scheme. The scheme is implemented through the implementing agencies in the states. The agencies are provided with financial assistance for purchase, fabrication and distribution. Aids and appliances such as wheelchairs, crutches, calipers, hearing aid, Braille slates, etc. are given to different categories of disabled persons. (Refer Table III.1.3). Eligibility of the beneficiaries: A person with disability(ies) would be eligible for assistance under ADIP scheme through authorized agencies, if the following conditions are fulfilled: i) He/She should be an Indian citizen of any age. ii) Should be certified by a registered medical practitioner that he/she is disabled and fit to use the prescribed aid or appliance. iii) Person who is employed/self-employed or getting a pension, and whose monthly income from all sources does not exceed Rs.8,000/- per month. iv) In case of dependents, the income of parents/guardians should not exceed Rs.8,000/per month. v) Person should not have received assistance from the government, local bodies and non-official organizations during the last 3 years for the same purpose. However, for children below 12 years of age this limit would be 1 year. Types of aids/appliances to be provided: The following aids and appliances may be allowed for each type of disabled individual. However, any other item as notified from time to time by the Ministry of Social Justice and Empowerment for this purpose will be allowed. Locomotor disabled 1. All types of prosthetic and orthotic devices. 2. Mobility aids and like tricycles, wheelchairs, crutches/walking sticks and walking frames/rolators. 3. All types of surgical footwear and MCR chappals. 4. All types of devices for ADL (activity of daily living) Visually disabled 1. Learning equipments like arithmetic frames, abacus, geometry kits etc. Gaint Braille dosts system for slow-learning blind children. Dictaphone and other variable speed recording system. Tape recorder for blind students up to XII th standard. 2. Science learning equipments like talking balance, talking thermometers, measuring equipments like tape measures, micrometers etc. 3. Braille writing equipments including baraillers, braille shorthand machines, typewriters for blind students after the XIIth class. Talking calculators, geography learning equipment like raised maps and globes. 4. Communication equipment for the deaf-blind. Braille attachments for telephone for deaf-blind persons. 5. Low vision aids including hand-held stand, lighted and unlighted magnifiers, speech synthesizers or Braille attachments for computers. 6. Special mobility aids for visually disabled people with muscular dystrophy or cerebral palsy like adapted walkers. Hearing disabled 1. Various types of hearing aids. 2. Educational kits like tape recorders etc. 3. Assistive and alarming devices, including devices for hearing of telephone, TV, doorbell, time alarm etc. 4. Communication aids, like portable speech synthesizer etc. Mentally disabled 1. All items allowed for locomotor disabled. 2. Tricycle and wheel chair including any modification to suit the individual. 3. All types of educational kits required for the mentally disabled. 4. Any suitable device as advised by the rehabilitation professional or treating physician. Multiple disabilities Any suitable device as advised by a rehabilitation professional or treating physician. Support to Organizations and NGOs under AIDP. The Ministry of Social Justice and Empowerment has supported 147 NGOs in 18 states for providing schemes under the Aid & Appliances support to disabled persons in the year 2000-2001. A total of Rupees 291 million were distributed to the Voluntary Organizations/ NGOs during 2000-2001. The state wise distribution of Aids and Appliance support was Rupees 105 for Uttar Pradesh, followed by Rupees 36 million for Rajasthan, 25 million for West Bengal, 21 million for Andhra Pradesh, 15 million for Maharastra, 12.1 million for Haryana, 12 million for Orissa, 11.9 million for Gujarat, 11.7 million for Delhi, 9.8 million for Himachal Pradesh, 9.6 million for Punjab, 7.6 million for Madhya Pradesh, 6.1 million for Tamil Nadu and 5 million for Karnataka. Other states received minor amount. The amount has been distributed through Voluntary and registered Organizations for providing appropriate Aids and Appliances to the identified disabled persons. (Refer Table No. III.1.3) Table No.III.1.3 Aids & Appliances Support to Voluntary Organizations of Expenditure 2000-01 Name of State Number NGOs Uttar Pradesh 30 (Million Rupees) 105.2 36 Rajasthan 2 36.0 12 West Bengal 11 25.6 9 Andhra Pradesh 14 21.1 7 Maharastra 9 15.9 6 Haryana 11 12.1 4 Orissa 6 12.0 4 Gujarat 6 11.9 4 Delhi 8 11.7 4 Himachal Pradesh 6 9.8 3 Punjab 7 9.6 3 Madhya Pradesh 10 7.6 2 Tamil Nadu 12 6.1 2 Bihar 6 2.2 1 Kerala 2 1.9 1 Manipur 4 1.0 1 Karnataka 1 0.5 0 Goa 1 0.1 0 Tripura 1 0.07 0 ALL 147 291.0 100 %Expenditure total to Source: Annual Report 2000-2001, Ministry of Social Justice and Empowerment, Government of India. II. Assistance to NGOs for Establishment and Development of Special Schools: The scheme envisages assistance to the NGOs up to the extent of 90 per cent for establishment and up gradation of special schools in the four major disability areas orthopaedic, hearing and speech, visual and mentally retarded. Priority under the scheme is given for setting up of schools in districts where there is no special school at present. Both recurring and non-recurring expenditure is supported. The Ministry of Social Justice and Empowerment, Government of India supported 576 Voluntary Organizations and NGOs during 2000-01, under its umbrella scheme for providing assistance to disabled persons at micro levels in their host localities. An amount of Rupees 550 million was provided to the NGOs for providing assistance and other support facilities to the identified disabled persons. An amount of Rupees 128 million was disbursed for NGOs in Andhra Pradesh, followed by 87.3 million for Uttar Pradesh, 64.9 million for Delhi, 64 million for Karnataka, 49.2 million for West Bengal, 48.3 million for Kerala, 39.6 million for Tamil Nadu and 25.2 million for Orissa. (Refer Table III.1.4) III. Assistance to Voluntary Organizations for the Rehabilitation of Leprosy-Cured Persons. : India has a large population of leprosy-affected persons; the figure is estimated to be 450,000. The scheme is designed to provide financial assistance to NGOs in a phased manner for the rehabilitation of leprosy-cured persons both in rural and urban areas. Assistance is given up to 90 per cent of the project cost. Programs like awareness generation, early intervention, educational and vocational training, economic rehabilitation, social integration, etc. are undertaken under the scheme. IV. Assistance to Organizations for Persons with Cerebral Palsy and Mental Retardation (NTMRCP): Under the scheme, assistance is given to NGOs up to the extent of 100 per cent for running training courses for teachers in the area of cerebral palsy and mental retardation. Both recurring and non-recurring items are considered for sanctioned under the National Trust for Mentally Retarded and Cerebral Palsy (NTMRCP). Table No.III.1.4 Scheme of AIDS & APPLIANCES for Voluntary Organization/ NGOs Expenditure in Rs (Million) 2000-01 State-wise Number of NGOs and Assistance Given under Scheme to Promote Voluntary Action for Persons with Disabilities (During 1999-2000 to 2001-02) (Rs. in Lakh) States/UTs Nos. Andhra Pradesh Arunachal Pradesh Assam Bihar Chandigarh Chhatisgarh Dadra & Nagar Haveli 19992000 Amount 84 2 3 11 2 - 20002001 Nos. 1208.35 13.00 30.56 57.68 1.42 - 2001-2002 Amount 91 1 8 8 2 1 - Nos. 1283.57 6.32 40.11 162.47 6.57 9.08 - Amount 106 2 13 19 2 3 1 % 1151.64 18.98 51.41 225.42 5.22 12.49 1.53 19 0.31 0.84 3.7 0.08 0.20 0.02 Delhi Goa Gujarat Haryana Himachal Pradesh Jammu & Kashmir Jharkhand Karnataka Kerala Madhya Pradesh Maharashtra Manipur Meghalaya Mizoram Nagaland Orissa Pondicherry Punjab Rajasthan Sikkim Tamil Nadu Tripura Uttar Pradesh Uttaranchal West Bengal India 31 2 17 10 1 2 58 49 8 26 7 4 1 21 2 10 6 34 1 67 43 502 679.04 17.68 75.36 59.51 32.42 7.24 571.99 442.04 17.43 263.72 57.06 17.41 25.31 193.96 1.44 64.94 88.13 325.69 6.83 772.39 365.53 5396.13 34 2 25 15 2 3 57 55 10 18 5 4 3 1 24 1 11 11 37 1 57 5 42 534 649.54 12.64 114.52 95.44 15.85 12.23 640.58 483.72 39.32 197.99 56.63 46.38 29.52 2.83 252.26 6.59 91.39 93.99 396.07 6.02 873.19 95.85 492.52 6213.19 36 3 17 17 3 4 3 67 62 15 27 8 5 2 1 27 1 11 22 1 50 1 59 8 48 644 527.78 24.07 125.83 73.42 24.49 4.36 7.00 658.89 539.83 79.19 209.39 59.89 60.10 30.06 1.78 313.47 5.85 79.85 155.81 1.94 426.57 6.50 715.33 35.18 448.64 6081.91 8.67 0.39 2.06 1.20 0.40 0.07 0.01 10.83 8.87 1.30 3.44 0.98 0.98 0.49 0.02 5.15 0.09 1.31 2.56 0.03 7.01 0.10 11.76 0.57 7.37 100 V. Science and Technology Development Projects in Mission Mode (TDMM): With a view to mainstream the disabled the TDMM scheme was launched in 1988 to provide suitable and cost-effective aids and appliances through the application of technology. Its aims are to improve the mobility, employment opportunities and integration of the disabled persons. Science and Technology Projects in Mission Mode represent a new approach aimed at ensuring that emerging inter-disciplinary efforts are developed to have the potential to meet a large scale societal/national needs, and can fulfil their potential in a time-targeted manner. The emphasis is on an end-to-end approach covering Research and Development as well as technological, financial, administrative and management aspects. These projects concentrate on new scientific inputs, generation of new technologies and guiding these to large-scale use. The objectives of such projects are to coordinate, fund and direct application of technology for development and utilization of: (a) Suitable and cost effective aids and appliances (b) Emphasis on education opportunities for employment and skill development leading to enhancement of (c) Easier living and integration in society. The Government of India had launched for the first five years a coordinated program for developing aids and appliances for persons with disability. The financial assistance is provided on a 100 per cent basis. Some interesting and innovative products, for the use of persons with disabilities, have been developed by organizations funded under this scheme. These are: o o o o o o o o o o o Speech Synthesizer Inter pointing Braille writing frame Close Circuit TV with magnification facility Photo-voltaic charger Safety devices for agricultural machinery Feeding aids for children with cerebral palsy Multifunctional wheel-chair Electronic guide stick Tele film for training of parents of mentally retarded Video films on safe use of agricultural machinery Microprocessor based braille embosser. VI. Office of the Chief Commissioner for Persons with Disability (CCPD): The Chief Commissioner for Persons with Disabilities (CCPD) is a statutory authority having quasi-judicial powers under the PWD Act 1995. The functions and duties of the Chief Commissioner include inter-alia coordinating the work of state commissioners for persons with disabilities, monitoring utilisation of funds disbursed by the central government, taking steps to safeguard rights and facilities made available to persons with disabilities and also to look into complaints with disabilities and also to look into complaints with respect to denial of rights of persons with disabilities. The CCPD has launched a pilot project in collaboration with the State Governments for setting up Mobile Grievance Cell (MGC) with the aim of Delivering justice at the doorstep of citizens with disabilities. Minimizing the cost of approaching courts for Redressal of complaints Sensitising NGOs and persons with disabilities about their entitlements. VI. Financial Allocation for Disability Sector in India: A total of Rupees 2301 million has been allocated and spent for disability sector for the year 2000-01 in India. The budget head expenditure indicates that 23.9% were allocated for support through voluntary organizations and NGOs. Another 19.12% was spent through NTMRCP for cerebral palsy and mental retardation programme, while 18. 68% of the budget was spent on National rehabilitation programmes for other disabled persons. (Refer Table No. III.1.5) Table NO. III.1. 5 India Budget Allocation and Expenditure on Welfare of Disabled in (Rupees in Million) Scheme NIVH NIOH NIHH IPH NIMH NIRTAR National Institute for the Multiple Handicapped Employment of Handicapped Budget 2000-01 Percent 22.5 0.97 22.5 0.97 26.3 1.14 13.5 0.56 29.7 1.29 36.0 1.56 10.0 0.43 16.0 0.69 Technology Development Mission Mode (TDMM) 10.0 ALIMCO 67.5 NTMRCP 440.0 RCI 70.0 ISIC 22.5 NHFDC 120.0 National Rehabilitation Programme 430.0 Office of the Chief Commissioner of Persons with 10.0 Disability (CCPD) Implementation of PWD ACT 117.5 Support to Voluntary Organizations for Aids and 287.0 Appliance Support to Voluntary Organizations for Voluntary 550.0 Action Support ALL 2301.0 0.43 2.93 19.12 3.04 0.97 5.21 18.68 0.43 5.10 12.47 23.90 100 Source: Annual Report 2000-2001, Ministry of Social Justice and Empowerment, Government of India. Concessions and Facilities Concessions and Facilities Provided by Central and State Governments [13]: The Central and State Governments have provided some facilities and concessions for the benefit of disabled people to integrate them into the mainstream. The facilities and concessions are: 1. Scheme of Integrated Education 2. Job Reservation in Government Sector 3. Economic Assistance 4. Welfare Schemes 5. Travel Concessions Schemes for Integrated Education: The scheme of Integrated Education for the Disabled Children (IEDC) is a Centrally sponsored scheme and is being implemented by the Department of Secondary and Higher Education under the Ministry of Human Resource Development since 1982. Under this scheme, children with disabilities are encouraged to be integrated in the normal school system. States and Union Territories (UTs) are provided assistance for education of the children with disabilities in general schools. The assistance provided includes the provision of necessary aids, incentives and specially trained teachers. A three- member team comprising of a doctor, a psychologist and a special educator is formed for assessment of the disability among school going children. The target groups covered under this scheme includes: 1. Children with locomotor handicaps (Orthopaedically Handicapped (O.H.)) 2. Mildly and moderately hearing impaired. 3. Partially sighted children. 4. Mentally handicapped-educable group (IQ 50-70) 5. Children with multiple disabilities (visual and orthopaedic impairment; hearing and orthopaedic impairment; educable mentally retarded and orthopaedic impairment; visual and mild hearing impairment) 6. Children with learning disabilities. The following monetary allowances are permitted for the disabled children under this scheme: Books and Stationery allowance of Rs.400/- per annum. Uniform allowance of Rs.50/-per annum. Transport allowance of Rs.50/- per month (if a disabled child admitted under the scheme resides is in a hostel of the school within the school premises, no transportation charges would be admissible). Reader allowance of Rs.50/- per month in case of blind children after class V. Escort allowance for severely handicapped children with lower extremity disabilities @ Rs.75/- per month. Actual cost of equipment subject to a maximum of Rs.2000/- per student for a period of five years. Other Concessions. 1. In the case of severe degree of orthopaedically handicapped children, it may be necessary to allow one attendant for 10 children in a school. The attendant may be given the standard scale of pay prescribed for Group D employees in the State/U.T. concerned. 2. Disabled children residing in hostels within the same school where they are studying may get boarding & lodging charges as admissible under the state government regulations. In case there is no state scheme of awarding scholarship to such hostel residents, then each one of them is eligible to receive the actual boarding & lodging charges subject to a maximum of Rs.200/- per month. This allowance does not apply if the income of the parents exceed Rs.3000/- p.m. 3. Severe orthopaedically handicapped children residing in school hostels may need a helper or an Ayah. A special pay of Rs.50/- p.m. is admissible to any employee of the hostel willing to extend such help to the children in addition to the usual duties. 4. If there are at least 10 handicapped children enrolled in a school located in a rural area, then an allowance of Rs.300/-p.m. is allowed so as to meet the expenses of their free transportation by a rickshaw. This allowance also covers the capital cost of the rickshaw and labour charges of rickshaw puller. No individual transport allowance is then admissible for the students. 5. Grant of education allowance to the children & reimbursement of the tuition fee for Central Government employees will be governed by the Central Civil Services (Education Assistance) Orders, 1988. Under this order, the reimbursement of tuition fee in respect of physically handicapped and mentally retarded children of the Central government employees has been enhanced to Rs.50 p.m. (from class I to XII) in comparison to the general category where it is only Rs.20.p.m. The disabled children will, however, get other assistance under this scheme as per rates prescribed for the normal children Scholarships/ Fellowships for Disabled Persons: Scholarships for disabled persons from class IX onwards have been transferred to state and union territory administration. The scholarships under this scheme are limited to a maximum period of 6 years after class XII. Income limit of parents/ guardians of the candidates should not be more than Rs. 2000 per month. In addition to monthly scholarships the candidates are also eligible to receive Readers Allowance. The University Grants Commission has reserved 1% of the fellowships allocated to the universities for the handicapped. Job Reservation in Government Sector under PWD Act- 1995. Since 1977 Government establishments are providing 3% reservation for the disabled in respect of Group C and Group D posts. After the enactment of the PWD Act, this reservation has also been extended in Group A and B identified posts. Identification of posts for persons with disabilities in all four groups has already been done in 1986 by the central government. A committee was set up to modify the identification of posts in view of the PWD Act 1995. Identification of the posts has been completed. As per the order of government of India, reservation of 3% in jobs has been made in the identified posts for the physically handicapped persons in all the four Grades. One percent jobs each has been reserved for blind, deaf and orthopaedically handicapped. For effective implementation of the reservation it has been advised to maintain a roaster of vacancies arising on a yearly basis. In this way every Ist, 34th & 67th vacancy is earmarked for the disabled in the cycle of 100 vacancies. A Committee has already identified appropriate posts for the physically disabled. The other concessions include. In order to implement these reservations without loss of productivity, some posts are identified disability wise. Disabled persons recruited for regional Grade C and Grade D posts may be given their posting (as far as possible) near their native place in that region subject to the administrative constraints. PH employees may be given preference in transfer near their native place. The ban on filling up of non-operational vacant posts will not be applicable for reserve vacancies to be filled up by PH persons. If a reserve category of person is not available and the nature of vacancy in an office is such, it may be carried forward for a period of three subsequent years. It has been instructed that recaning of chairs in government offices should be reserved for blind persons as far as possible. When the volume of work require a full time chair caner then a suitable post may be created in consultation with the finance department. For the purpose of recaning the chairs in government offices, vocational rehabilitation centres and special employment exchange for the PH persons may be contacted. All the vacancies irrespective of their nature and duration are to be notified to the employment exchange and required to be filled through this agency unless they are filled through UPSC/SSC. It has also been decided that all of the appointees should send their request to Employment Exchange/Special Employment Exchange/nearest Vocational Rehabilitation Centres for P.H. for nominating suitably handicapped persons to fulfil specific opportunities. Extension of the age concession/ relaxation upwards by 10 years in favour of handicapped persons. This applies to posts filled through the SSC and through Employment Exchange. Physically Handicapped persons who are otherwise eligible for appointment to posts of Lower Division Clark but cannot be so appointed due to their inability to satisfy the typing qualifications may be exempted from this requirement. Physically Handicapped persons recruited to Grade. B and Grade. C posts advertised by the UPSC and SSC will be exempted from the payment of application and examination fee as prescribed by UPSC/SSC. Physically Handicapped persons with disability of upper or lower extremities are to be grated conveyance allowance at 5% of basic pay. Under the All India Service (Special Disability Leave) Regulation, 1957, special leave may be granted to a member of the service employee who suffers a disability as a result of risk of office or special risk of office. The special leave is subject to certain conditions. (Refer Annexure-) Income Tax Concessions under Income Tax Act, 1961 There are special provisions, which provide exemptions in the Income Tax Act for persons with disability and for the parents/ legal guardians of persons with disability. The relevant sections are: Section 80 DD: Section 80 DD provides for a deduction in respect of the expenditure incurred by an individual or Hindu Undivided Family resident in India on the medical treatment (including nursing) training and rehabilitation etc. of handicapped dependants. For officiating the increased cost of such maintenance, the limit of the deduction has been raised from Rs.12000/- to Rs.20000/-. Section 80 V A new section 80V has been introduced to ensure that the parent in whose hands income of a permanently disabled minor has been clubbed under Section 64, is allowed to claim a deduction up to Rs.20000/- in terms of Section 80 U, which provides for a deduction of Rs. 20000 in case of an individual who is suffering from a permanent disability (including blindness) or is subject to mental retardation. Deductions are allowed to persons making donations to registered trusts and societies doing work for the handicapped. The relevant sections are 80G and 80GGA. Under Section 80G deduction from income is allowed at 50 percent of the amount donated to the eligible institution. The amount on which deduction is claimed under the section, however, cannot exceed 10 percent of the gross total income exemptions. This is only in respect of certain specific projects for research, development etc. (Section 80GGA) All assesses, i.e., individuals, Companies etc, may claim deductions in respect of donations. Differential Rate of Interest: Public Sector Banks Under the Scheme of Public Sector Banks for Orphanages, Womens Home and Physically Handicapped persons, the benefits of the deferential rate of interest are available to physically handicapped persons. Physically handicapped persons are eligible to take loans under this scheme, if they satisfy the following conditions: - Should be pursuing a gainful occupation - Family income from all sources should not exceed Rs.7200/ p.a. in urban or semi-urban areas or Rs. 6400/ p.a. in rural areas - Should not have a land holding exceeding 1 acre if irrigated and 25 acres if un-irrigated - Should not incur liability to two sources of finance at the same time - Should work largely on their own and with such help as from another family member or a joint partner(s); and should not employ paid employees on a regular basis. Financial Assistance Available To Persons With Disabilities through NHFDC: The National Handicapped Finance and Development Corporation (NHFDC) has been incorporated by Ministry of Social Justice & Empowerment, Government of India on 24th January 1997 under section 25 of the Companies Act, 1956 as a company not for profit. It has an authorised share capital of Rs 4,000,000,000 to make the persons with disabilities, productive and bring them into the mainstream of economic activity. It runs several schemes to financially assist the disable persons who are eligible for this purpose. Eligibility Any Indian citizen with a 40% or more disability. Age between 18 and 55 years. Annual Income below Rs.60,000/- per annum for urban areas and Rs.55,000/- p.a. for rural areas. A cooperative society of disabled persons. A legally constituted association of disabled persons. A firm promoted by disabled persons. Each member of society/association/firm applying for loan should fulfil the disability, age and income criteria. Relevant background of educational / technical / vocational qualification or experience, to ensure an appropriate usage of the assistance. The corporation assist a wide range of income generating activities for disabled persons. These are:For setting up small business in service/-trading sector: Loan up to 20.00 lakhs. For setting up small industrial unit: Loan up to Rs.20.00 lakhs. For higher studies/professional training to cover tuition fees books, stationery expenses, hostel facilities etc. For agricultural activities: Loan upto Rs.5.00 lakhs. For manufacturing /production of assistive devices for disabled persons: Loan upto Rs.25.00 lakhs. For self-employment amongst persons with mental retardation, Cerebral Palsy and Autism: Loan upto Rs.2.50 lakhs. Note: a) All loans are to be repaid within 7 years. b) A rebate of 2% on interest for disabled women is given. c) A rebate of 0.5% on interest for timely and full repayment of loan & interest. Subsidy To Disabled Under Swarnjayanti Gram Swarozgar Yojana (SGSY) This scheme was launched in 1999 with an aim to lift the poor families above the poverty line by providing them income-generating assets through a mix of bank credit and government subsidy. The list of BPL (below poverty line) households, identified through BPL census, duly approved by the Gram Sabha forms the basis for assistance to families under SGSY. This scheme covers all aspects of self- employment, which include organization of the rural poor in to self-help groups (SHG), training, planning of activity clusters, infrastructure build up, technology and marketing support. In the case of disabled persons, a SHG may consist of a minimum of 5 persons belonging to the families below poverty line. Three percent quota is earmarked for the disabled persons under the SGSY. The subsidy limit under the scheme is Rs. 7500/- (30% subsidy) for an individual and Rs.1.25 lakh for a group (50% subsidy). This scheme is being implemented by the District Rural Development Agencies (DRDAs) along with the involvement of Panchayati Raj Institutions, the banks, and the non- government organizations. Concessions in Postage/ telephone connections as per Post Office Guide: Payment of postage, both inland and foreign, for Blind Literature packets is exempted if sent by surface mail. If packets are to be sent by air, then prescribed airmail charges are applicable. Telephone facilities to blind persons on concessional and priority basis are also provided. Educated unemployed persons are eligible for allotment of STD/PCOs. Customs Concessions: The Central Government exempts specified goods used by disabled persons, when imported into India for his/her personal use. Award of Dealerships or Agencies by Oil Companies: The Ministry of Petroleum & Natural Gas has reserved 7% of all types of dealership agencies of the public sector oil companies for physically handicapped, government personnel (other than defense personnel; disabled on duty) and the widows of government personnel (other than defense personnel who die in the course of duty) Indira Awaas Yojana (IAY) It is a centrally sponsored housing scheme for providing dwelling units free of cost to the rural poor living below the poverty line at a unit cost of Rs.20,000/ in plain areas and Rs.22,000/- in the hilly/difficult areas. Three percent of its funds are reserved for the benefit of disabled persons living below the poverty line in rural areas. Ad-hoc allotment of general pool residential accommodation to the physically handicapped employees is allowed on request after recommendation of the special recommendation committee and on approval of the Ministry of Urban Affairs and Employment. Travel Concession for Disabled: Train Travel: As per an order of Ministry of Railways, Government of India, the following concessions are available to the disabled persons for travelling in Indian Railways. The disabled person (Persons with visual, orthopaedic, deaf and dumb and mentally retarded, along with escort is entitled for travel concession. Air Travel: The Indian Airlines Corporation allows 50% concessional fare to blind persons on a single one-way journey or single fare for round trip journey on all domestic flights. In a recent decision the Supreme Court of India (AIR 1999 S.C.512) has held that the government should give same concession as for the blind to any passenger travelling by Indian Airlines who has 80% locomotor disability. They are allowed to carry a pair of crutches/brases or any other appropriate prosthetic devices free of charge. Subsidy on purchase of petrol/ diesel to physically handicapped persons. Physically handicapped owners of motorized vehicles are granted exemption from the payment of road tax by state governments/ union territories administrations and are eligible to claim up to 50% of the expenditure incurred by them on purchase of petrol/ diesel from recognized dealers to a ceiling of up to 15 liters per month for vehicles up to 2 Horse Power and 25 liters per month for vehicles above 2 Horse.Power. Implementation Status of the PWD Act 1995 Provisions: The PWD Act 1995 has given the Chief Commissioner for Persons with Disabilities (CCPD) quasi-judicial powers to ensure all sections of the Act are implemented. CCPD is empowered to seek information from the ministries and influence them to follow the Act in its true letter and sprit. Any violations are informed to the CCPD, which in turn seeks redressal of the violations from the appropriate departments. The implementation status of the sections of PWD-Act 1995 is as follows. [14] SECTION 3-12 of PWD ACT 1995 (Constitution of Central Coordination Committee and Central Executive Committee) o o o Central Coordination Committee was constituted on 15th September 1997 and reconstituted on 9th September 1998. It has already held 5 meetings till May 2002. Central Executive committee was constituted on 15-9-1997 and 7 meetings have been held till 28-8-02 SECTION 13 and 17 of PWD ACT 1995 (Constitution of State Coordination and State Executive Committee) State Coordination Committee (SCC) ha been formed in only 23 states. The states of Delhi, Chhattisgarh, Mizoram, Jharkhand and Uttranchal had not formed (SCC) until 2002. State Executive Committee formed in 24 states, however no such committee is formed in Delhi, Mizaram, Jharkhand and Uttranchal as of 2002. SECTION 60 of PWD ACT 1995 (Appointment of State Commissioners) State Commissioners have been appointed in all states and union territories. The states of Gujarat, Nagaland, Punjab, West Bengal, Andhra Pradesh, Tamil Nadu, Maharastra, Jharkhand and Chattisgarh have full time Commissioner with independent charge, while 19 states 5 union territories (UTs) have commissioners with additional charge. SECTION S 50 of PWD ACT 1995 (Appointment of Competent Authority) The Competent Authority has been appointed in all states and UTs except for Bihar, Arunachal Pradesh and Anadaman & Nicobar islands. SECTION 26A of PWD ACT 1995 (Free and Appropriate Education) Already implemented in 20 states and 3 UTs and action pending in 8 states and 3 UTs. SECTION 27 a-e of PWD ACT 1995 (Non-formal Education) o o o Implemented in 10 states and union territory of Pondicherry. Action initiated / pending implementation in 19 states and 5 UTs. States from North East expressed inability to adopt it either due small disabled population or due to paucity of funds etc; SECTION 32 of PWD ACT 1995 (Identification of Jobs) o o o o o o Identified for all four categories of A, B, C, D, Groups in Mizoram, Punjab, Rajasthan and Haryana. Identified for A and B Groups only in Himachal Pradesh and Tamil Nadu. Identified for B, C and D Groups in Madhya Pradesh and Orissa. Identified only for C and D Groups in Andhra Pradesh, Goa, Karnataka, Kerala, Maharastra, Manipur, Tripura, Uttar Pradesh, and west Bengal. Action pending for job identification in Delhi, Gujarat, Nagaland, Sikkim , Uttranchal, Chattisgarh and Jharkhand. Not Identified in Meghalaya, Arunachal Pradesh, Bihar, Assam, A&N islands, Lakshawdeep, Chandigarh, Pondicherry and Daman & Diu. SECTION 33 of PWD ACT 1995 (3% Job Reservation) o o o o o Implemented for Groups of A, B, C and D in Mizoram, Punjab, Rajasthan and Haryana. Implemented for Groups A and B only in Tamil Nadu and Himachal Pradesh. Implemented for Groups B, C and D in Madhya Pradesh (6% reservarion) Dadra & Nagar Haveli, Orissa . Implemented for Groups C and D only in Karela, Uttar Pradesh, Andhra Pradesh, Assam, West Bengal, Delhi, Goa, Himachal Pradesh, Manipur, Tripura and Karnataka (5% reservation). Reservation exists despite not identified as per old law of 1987 in Gujarat (4%), Sikkim, Uttranchal, Chattisgarh, Jharkhand and Assam o No provision of reservation in Arunachal Pradesh, Bihar, Nagaland and Meghalaya. SECTION 39 of PWD ACT 1995 (3 % Reservation in Government and Government aided Educational Institutions) o o o Implemented in all technical and general government and government aided education institutions for Goa, MP, Rajasthan, UP, Kerala, AP, Assam (MBBS only), Delhi, Gujarat, HP (ITI), Karnataka, Manipur, Sikkim, Tamil Nadu, Pondicherry and Dadra an d Nagar Haveli. Instruction issued for reservation in Haryana, Maharastra and Tripura. No-Action taken in Arunachal Pradesh, Bihar, Mizoram, Meghalaya, Nagaland, Orissa and West Bengal. SECTION 40 of PWD ACT 1995 (3 % Reservation in Poverty Alleviation Programmes) o o o o Implemented in 12 states and 1 union territory namely Andhra Pradesh, Goa, Gujarat, HP, Karnataka, M.P, Meghalaya, Nagaland, Rajasthan, Tripura, UP, West Bengal. Instruction issued in 4 States and 1 UT namely Haryana, Maharastra, Punjab, Tamil Nadu and Pondicherry. Pending in Assam and Manipur No-Action taken in 10 states and 5 U.T: Arunachal Pradesh, Bihar, Delhi, Kerala, Mizoram, Orissa, Sikkim, Jharkhand, Chattisgarh and Uttarnchal . SECTION 41 of PWD ACT 1995 (Incentives to Employers) Awards Given only in 6 states and 1 UT: Maharastra, Tamil Nadu, West Bengal, Andhra Pradesh, Gujarat and Pondicherry. SECTION 43 of PWD ACT 1995 (Preferential Allotment of Land) o o o o o Implemented for all purposes: 7 states of, Goa, Mizoram, Tripura, Manipur, Punjab, Rajasthan and Tamil Nadu. Implemented in housing schemes: 6 states of Haryana, Andhra Pradesh, Himachal Pradesh, Kerala, Uttar Pradesh, West Bengal, Bihar ( in some districts only). Land allotment implemented in Dadra & Nagar Haveli and Pondicherry. Pending action in 6 states: Assam, Karnataka, M.P, Maharastra, Sikkim and Tripura. No action taken: 6 states & 5 UT: Delhi, Gujarat, Mehgalaya, Nagaland, Orissa and UP. SECTION 45-46 of PWD ACT 1995 (Barrier Free Environment) Office of CCPD has brought out one manual containing guidelines for making barrier free environment (Planning a Barrier Free Environment) as a result of recommendations and access audits conducted by Resource Persons and Participants during workshops in various parts of the country. The programme has been partially implemented in: o o o o o Tamil Nadu in majority of public places. Delhi (IG stadium, SSC Building, Delhi University, Khalsa College, Bangla Saheb, Talkatora Stadium, Vigyan Bhawan, J.N. university, several public parks, New Delhi Railway Station, Airport, several restaurants etc; Chandigarh Punjab (selected districts) Two low floor technology buses introduced specially in Karnataka & Maharastra. o Special couches in railways have been installed for disabled. SECTION 73 of PWD ACT 1995 (Notification of Rule) The rule has been notified in 10 states and 2 UT: Goa, UP, W.B, Manipur, Tripura, AP, Assam,Haryana, Kerala, Punjab, Pondicherry and Lakshadweep. [1] Web Site of National Handicapped. http://disabilityindia.org/ Institute [2] Web Site of National http://disabilityindia.org/ for [3] Web Site of National http://disabilityindia.org/ Institute Institute [4] Web Site of National http://disabilityindia.org/ for Institute the for the for Hearing the Visually Handicapped . Orthopaedically Handicapped. the Handicapped. Mentally [5] Web Site of the Institute for the Physically Handicapped. http://disabilityindia.org/ [6] Web Site http://disabilityindia.org/ [7] Website of Rehabilitation Council of India. [8] Web Site http://disabilityindia.org/ [9] Web Site http://disabilityindia.org/ [10] Web Site http://disabilityindia.org/ and Annual Report , Ministry of Social Justice and Empowerment 2001-02 [11] Rehabilitation Council of India: Disability Status in India - 2000 [12] Web Site http://disabilityindia.org/ [13] Rehabilitation Council of India ( 2000) : Disability Status in India. [14] Annual Report of the Chief Commissioner of Persons with Disability 2002-03. PART- IV Delhi Disabled populalation- Magnitude and Services Delhi Metropolitan Region: Delhi, the national capital of Indian Union is one of the most rapidly growing mega cities in the country after the independence. The population of Delhi state was 13.78 million in 2001 as compared to 9.4 million as per the 1991 census records. According to the Census 2001, Delhi has been divided into 9 districts, keeping in view the locational coordinates. Ninety three percent of the population was dwelling in urban areas, while 7% population were localized in rural areas. The gender composition constitutes of 55% males and 45% females. Delhi registered sex ratio of 821 (females per 000' males) in 2001. (Refer Table No.1). Table No.IV.1.1 Delhi, Population 2001 (In 000') Name Of Rural District M F North 146 West North 26 North East 76 East 10 New Delhi 0 Central 0 West 48 South 122 West South 104 All Delhi 533 M+F 117 Rural Urban M 263 20 65 8 0 0 37 101 80 429 Urban + F M+F 1418 1165 M 2583 F 1564 M+F 1283 2847 46 141 18 0 0 85 223 401 876 775 96 349 1109 858 733 1622 1430 171 644 2034 1525 427 953 785 95 349 1158 980 352 810 663 75 294 961 768 779 1763 1448 171 644 2119 1749 184 963 1152 921 2073 1256 7037 5782 12819 7570 1001 6212 2258 13782 332 746 655 75 294 924 667 Source: Census of India 2001- Population Total The history of peopling of Delhi is a record of constant impulses of migrations during the historical period as well as in the wake of partition of the country in 1947. The migration streams into Delhi are also continuing during post independence period as the decadal population recorded more than 50% growth rates from 1951 onwards. This large-scale in-migration of population streams has been witnessed from surrounding and far-flung states due to variety of geo-political and economic reasons. The decade of 1941-51 registered population growth rate of 90% in the wake of partition of the country followed by decadal growth rate of 50-54% during the subsequent decades because of concentration of administrative and economic activities. The decade of 1991-2001 recorded decadal growth rate of 46.30%. (Refer Table No. IV.1.2 and Diagram No. IV.1.1) The link ed image cannot be display ed. The file may hav e been mov ed, renamed, or deleted. Verify that the link points to the correct file and location. Table No. IV.1.2 Delhi Population Growth 1941-2001 Year 1941 1951 1961 1971 1981 1991 2001 Population 923,789 1,764,876 2,667,765 4,076,980 6,220,406 9,420,644 13,782,976 Decadal Growth Rate 90.0 52.44 52.93 53.73 51.45 46.30 The link ed image cannot be display ed. The file may hav e been mov ed, renamed, or deleted. Verify that the link points to the correct file and location. Figure No. IV.1.1 Disabled Population in Delhi Magnitude: Unfortunately disability data of the Census 2001 has not been published so far, and no reliable data is available to estimate the magnitude of disabled population in the country including Delhi. However for the first time the NSSO 58th Round has collected sample data on disability covering the areas of Delhi along with other areas of the country. [1] Based on the sample data collected by the NSSO 58th round, an estimated 77, 046 persons were projected as disabled persons, who were having at least one of the impairments in term of mental, vision, speech, hearing and locomotor disability. The gender distribution of disabled persons was 52,239 males and 24,102 females constituting 68% and 32% males and females respectively. (Refer Table Number IV.1.3). Table No. IV.1.3 Delhi Disabled Persons- Magnitude (2001) Type Disability Numbers Of Persons % to Male All Numbers Females % to All Numbers % to All Disabled Mentally 5937 Retarded Mentally Ill 4810 Blind 4055 Low Vision 1654 Hearing 5400 Impaired Speech Impaired 5917 Locomotor 54264 Impaired Any Disability $ 77046 7.70 Disabled 4012 7.68 Disabled 1925 7.89 6.24 5.26 2.14 7.00 2574 3558 909 3785 4.92 6.81 1.74 7.24 2236 497 745 1615 9.27 2.06 3.09 6.70 7.69 70.43 4240 36870 8.11 70.57 1677 17394 6.95 72.16 52239 24102 Source: NSSO 58th Round 2002 and Census of India- Delhi Population - 2001 The prevalence rates for all disability groups (per 100,000 persons) presented in NSSO 58th Round, 2002 for Delhi state were considered as prevalence rates for 2001 population data. Accordingly number of disabled persons in each disability type / group have been worked out for 2001 for Delhi. At least one of the mental, vision, speech, hearing and locomotor disability Majority of the disabled persons (70.43%) were locomotor impaired followed by mentally retarded (7.70%), speech impaired (7.69%), hearing impaired (7%), mentally ill (6.24%), blind (5.26%) and low vision (2.14). The disability type distribution for both gender groups depicts similar proportions except for the fact, that females had higher cases of mental impairment and lower cases of vision impairment compared to the male counterparts. (Refer Table No. IV.1.3 and Fig. No. IV.1.1) Disability Prevalence Rates: The prevalence rates (per 100,000 persons) for all the disability types covered by the NSSO 58th round in 2002 have been depicted in Table No. IV.1.4 for Delhi. In comparison to the all India prevalence rate figures presented in Part-II of this report, the prevalence rates for all types of disability in Delhi for both gender groups were very low. As compared to the prevalence rate (any disability) of 1755, 2000 and 1493 respectively for all persons, males and females for the all India, the figures were 559, 690 and 388 for all persons, males and females respectively for the Delhi state. Similarly the prevalence rates for all other disability types were much less in Delhi as compared to the all India. The lower disability prevalence rates are in spite of large scale rural to urban migrations for low profile jobs in Delhi. These migrants are usually landless labour forces without enough food security in the rural areas. Hence they are more prone to diseases and disability even in urban environments. Availability of immediate healthcare through a network of medical care centers and a strong awareness generated by NGOs and government machinery for complete immunization of both pregnant mother and child is one of the major reasons for lower disability prevalence rates in Delhi. (Refer Table No.IV.1.4 and Fig. No. IV.1.2) The locomotor impaired prevalence rates are significantly high as compared to the other disability types in Delhi. This could be attributed to large number of cases of traffic accidents and industrial occupational hazard accidents. However immediate and quick health care response to such accidents has reduced prevalence rates in Delhi as compared to other parts of the country. Moreover institutional and NGO sector services for disabled persons in Delhi are more accessible as compared to other areas. Table No. IV.1.4 DELHI Disabled Persons - Prevalence Rate (per 100.000 persons) 2002 Type Of Disability Persons Mentally Retarded 41 Mentally Ill 35 Blind 30 Low Vision 12 Hearing 40 Speech 44 Locomotor 398 Any disability having at least one of the above 559 disability Male 53 34 47 12 50 56 487 690 Female 31 36 8 12 26 27 280 388 Source: NSSO round 58th in 2002. Disability Incidence Rates: The disability incidence rates (The number of persons whose onset of disability by birth or after birth has been during the specified period of 365 days preceding the survey data collected by NSSO enumerators, per 100,000 persons) were 15, 15 and 14 for all persons, males and females respectively in the Delhi state as compared to 69, 76 and 60 for all persons, males and females respectively for the all India in 2002. Hence the incidence rates for any one of the disability types was also much lower in Delhi as compared to the all India data. Most cases of incidence of disability in Delhi were for locomotor impairment due to traffic accidents as well as due to occupational accidents in the small manufacturing units. These small manufacturing units have had a mushroom growth after globalization and out sourcing of jobs that employ females in large numbers to have maximum profits. The small manufacturing units have little safety measures in place hence occupational accidents are more prevalent. (Refer Table No. IV.1.5 and Fig. No. IV.1.3). Table No. IV.1.5 DELHI Incidence Rate (per 100,000 persons0 2002 All Disabled Rural Male Urban 22 2002 13 15 Female 0 19 14 Persons 13 15 15 Source: NSSO 58th Round in 2002 Disability Household Prevalence: Both R+U The average family size of households having disabled persons was 5.8 in Delhi according to the NSSO survey. About 94 % of the disabled households were having one-disabled persons while 6 % of these households had two disabled persons in urban areas of the state of Delhi. In the case of rural areas of Delhi 87% households having disabled persons had one- disabled person while 13% of disabled households have two-disabled persons. Thus rural areas had higher proportion of households having more than onedisabled person. (Refer Table No. IV.1.6) The link ed image cannot be display ed. The file may hav e been mov ed, renamed, or deleted. Verify that the link points to the correct file and location. Fig. No. IV.1.1 The link ed image cannot be display ed. The file may hav e been mov ed, renamed, or deleted. Verify that the link points to the correct file and location. Fig No. IV.1.2 The link ed image cannot be display ed. The file may hav e been mov ed, renamed, or deleted. Verify that the link points to the correct file and location. Fig. No. IV.1.3 Table No. IV.1.6 Delhi Disabled Households Having Number of Disabled Persons (Percent) Number of Disabled Persons in Disabled Households Rural Urban 1 (%) 87 2 (%) 13.0 3 and More (%) 0 Average Size of Households having disabled 5.8 persons ( in Number) 2002 93.5 61 3 5.8 Source: NSSO 58th round in 2002. Severity/ Degree of Disability: The NSSO survey has classified the severity/ degree of impairment for the identified disabled persons. Fortunately about 51.5% of the disabled can function without aid/ appliances, while 20.9% cannot function even with aid and appliance and another 21.3% can take self-care with the help of aid and appliance. Significantly 6.3% of the disabled have neither tried nor have access to aids and appliance and hence cannot take self-care in case of urban areas. In the case of rural areas 15.8% of the disabled have neither tried nor have access to aids and appliance and hence cannot take self-care. Thus availability and purchasing capacity of aids and appliances are less among rural disabled persons. Thus out-reach programmes for awareness and supply of free aids and appliances in rural areas need to be strengthened (Refer Table No. IV.1. 7 and Fig. No. IV.1.4). Table No.IV.1.7 Delhi Degree of Impairment 2002 (Percent) Degree of Impairment Rural Can not function even with aid Can function only with aid Can function without aid Aid/ appliance not tried/nor available ALL Disabled 2002 Urban 3.7 22.1 58.5 15.8 7,454 20.9 21.3 51.5 6.3 69,592 Source: NSSO 58th round in 2002. Disabled Persons Educational Levels: The distribution of disabled persons (aged 5 years and above) by level of general education (including illiteracy) was ascertained from the NSSO reports 58th round in 2002 for the state of Delhi. As expected about 24% disabled persons were illiterate in Delhi. But surprisingly contrary to the expectations illiteracy rate among the disabled was 14.8% in rural areas and 27.8% in urban areas. This could be attributed to the presence of disabled person in slum colonies, who have migrated from rural areas and their families push the disabled children for begging and other low profile jobs. Even among the disabled literates only 30% have education up to primary level, while 18% and 27% disabled persons were educated up to middle and secondary and above secondary level respectively. The rural/ urban areas in Delhi did not show any significant deviation in the educational levels except for the fact that rural areas hand slightly highly disabled literates up to primary and middle levels. Thus in spite of propagation of inclusive education for disabled in the normal schools and availability of a large number of institutional services through NGOs and other governmental organizations for education of disabled persons, the educational levels for disabled persons in Delhi are still poor and need immediate support and strengthening. (Refer Table No. IV.1.8 and Fig. No. Iv.1.5) Table No. IV.1.8 Delhi Educational Levels for Disabled Persons (Percent) 2002. Level of General Education Disabled aged 5 + years Rural Illiterate Up to Primary UP to Middle Secondary and Above ALL Disabled Persons for 2002 Urban 14.8 34.5 25.4 25.3 7,454 R+U 27.8 28.8 15.4 27.9 69,592 24.1 30.4 18.3 27.2 77046 Source: NSSO 58th round in 2002. Disabled Persons Vocational Training: Providing vocational training is one of the alternatives for making disabled persons secure, to earn their livelihood. Unfortunately in spite of several measures like opening of vocational rehabilitation centers by the Ministry of Labour and other NGOs supported by international donor agencies, yet only 12.3%, 8.9% and 9.9% disabled population had attended vocational training respectively in rural, urban and both rural and urban areas of Delhi state in 2002. Even among the disabled persons who received the vocational training, the nature of training received was in non-engineering skills, which fetch lower profile jobs and have lower income generation prospects. Thus majority of them lacked earning capacity through the training provided to them. Only 1.2% disabled persons had received vocational training in engineering skills. Thus the position of vocational training even in Delhi, the capital city with numbers of government and non-government institutions for disabled persons is pathetic and needs immediate attention of policy makers. The PWD-Act 1995 has not changed the scenario of job opportunities for the disabled inspite of reservations. (Refer Table No. IV.1.9 and Fig. No. IV.1.6) Table No. IV.1.9 Delhi Vocational Training for Disabled Persons 2002 Attending Vocational Courses for Disabled Aged 10+ Rural Urban Not Attending any Vocational Training 87.7 Attended Vocational Training 12.3 Attending Engineering Training 0 Attending Non-Engineering Training 12.3 ALL Disabled Persons 7,454 Source: NSSO 58th round, in 2002. The link ed image cannot be display ed. The file may hav e been mov ed, renamed, or deleted. Verify that the link points to the correct file and location. Fig. No. IV.1.4 2002 R+U 91.1 8.9 1.7 7.2 69,592 90.1 9.9 1.2 8.6 77046 The link ed image cannot be display ed. The file may hav e been mov ed, renamed, or deleted. Verify that the link points to the correct file and location. Fig. No. IV.1.5 The link ed image cannot be display ed. The file may hav e been mov ed, renamed, or deleted. Verify that the link points to the correct file and location. Services for Disabled Persons in Delhi: Several government and non-government organizations in Delhi metropolitan region provide institutional, educational, healthcare, vocational training, employment and rehabilitation opportunities to all types of physically and mentally impaired persons. Government support is provided through a network of specialized national institutes and their regional centers for specific disability groups as well as for composite physically and mentally impaired persons. The support is provided for special education, healthcare, free supply of aids and appliances, vocational training, employment opportunities, social services like scholarships, pension schemes and rehabilitation in homes and boarding schools. Several government centers, NGOs and other voluntary organizations are supported by Government of India, Ministry of Social Justice and Empowerment, Department of Education and Department of Women and Child Development, Ministry of Human Resources and other international donor agencies through the following schemes: Promotion of Voluntary Action for Persons with Disabilities 1) Assistance to Disabled for purchase of Aids and Appliances 2) Assistance for Integrated Education for Disabled 3) Special technical training courses for disabled 4) Rehabilitation of Disabled A number of National institutes and their collaborative regional centers are conducting long term/ short term/ diploma and bridge course to impart training skills for development of human resources in disability sector. Major specialized educational courses conducted in Delhi, by government and non-government organizations are depicted in Table No.IV.2.1. These courses cover one year to four-year period. Table No. IV.2.1 Educational Training Courses Conducted for Disability Sector in Delhi S.No 1 Name of Institution Disability Type Training Programme Institute of Physically Handicapped, New Delhi, Physically Disabled B.Sc. (Hons) 4, Vishnu Digambar Marg Physiotherapy New Delhi 110002 Occupational Therapy 2 Department of Rehabilitation, Multiple Disability DPOE Safdarjung Hospital, Ansari Nagar 3 New Delhi 110 016. All India Institute of Medical Sciences MRW Hearing Speech and B. Sc Ansari Nagar, New Delhi 110 016. DSE 4 Blind Relief Association, Lal Bahadur Shastri Visual Marg, New Delhi 110 003. 5 National Council of Education Research and Multiple Disability P.G Course Training, Sri Aurobindo Marg, New Delhi Guidance Counseling NIMH Regional Training Centre Mentally Retarded DSE 6 in and Kasturba Niketan, Lajpat Nagar 7 New Delhi 110 024. P.No. 6831012 Tamana Special School, D-6, Street, 8 Vasant Vihar, New Delhi 110 057. Spastics Society of Northern India Balbir Saxena Marg, Hauz Khas, New Delhi 110 016. Mentally Retarded DSE and Course Cerebral Palsy Neurological Handicapped / BDT Bridge 9 Institute for Special Education, Y.M.C.A. 10 Nizamudin, New Delhi 110 013. Amar Jyoti Rehabilitation and Research Centre, Mentally Karkardooma, Vikas Marg Delhi 110 092. Mentally Retarded DSE and Course DSE Retarded and Bridge Course Locomotor/ Multiple disability 11 E-mail: amarjoti@del2.vsnl.net.in Delhi Society for the Welfare of the Mentally Mentally Retarded DSE Retarded Children, Okhla Centre 12 Okhla Marg, New Delhi. AYJNIHH, NRC, Kasturba Niketan, Lajpat Nagar- Hearing Impaired/ DSE II, New Delhi 110 024. Speech 13 14 15 16 17 18 19 20 21 Bridge Samadhan , F. Block, Main Park, Sector-V, Mentally Retarded Dakshinpuri, New Delhi-62 National Association for the Blind (Delhi), Visually Impaired Sector-V, R.K.Puram, New Delhi 110 022. Kalucha Hansraj Model School , Asok Vihar, Mentally Retarded Delhi, Jan Madhyam, 148 A , Zamrudpur, New Delhi- Mentally Retarded 110048 Laxhman Public School, Haus Khas Enclave, Mentally Retarded New Delhi- 110016 Enabling Centre , Lady Irwin College, New Delhi Mentally Retarded Federation for the Welfare of the Mentally Mentally Retarded Retarded, Shaheed jeet Singh Marg, Spl. Institutional Areas, New Delhi 110 085. Air Force Golden Jubilee Institute, Subroto Park, Mentally Retarded Delhi Cantt, 110010 Akshay Pratisthan, D-III, Vasant Kunj, New Locomotor Delhi 110 070. Handicapped DHLS Bridge Course Bridge Course Bridge Course Bridge Course Bridge Course Bridge Course Bridge Course Bridge Course Bridge Course Note: D.P.O.E: Diploma in Prosthetics & Orthotics, M.R.W: Certificate Course in Multi Rehabilitation Worker, DSE: Diploma in Special Education, DHLS; Diploma in hearing, language and speech, Source: A Handbook for Parents of Children with Disabilities, Planning CommissionEducation Department, GOI, 2002.Rehabilitation Council of India, Status of Disability in India 2002 Ministry of Social Justice and Empowerment, GOI, Annual Report 2001-02 Vocational Training courses: Several government and non-governmental organizations are providing occupational skills to create employment avenues for the physically and mild mentally impaired persons. These courses are for short as well as for long periods to develop occupational skills. Free boarding facilities are provided in these centers for out-station physically impaired persons. Qualified trainers are imparting training to the participants. Regular contacts with entrepreneurs are created to seek employment avenues for the trained physically impaired persons. Some of the institutes providing vocational training to the target groups are depicted in Table No. IV.2.2. Table No. IV.2.2 DELHI Vocational Training Courses Conducted for Disability Sector S.No Name of Organization Disability Type 1. V.R.C. for Handicapped Physically Handicapped I.T.I. Campus, Pusa New Delhi 12. 2. 3. Courses Occupational Skill Provided Long Term/ Short Motor winding, Term carpentry, Beauty culture, Cutting, Tailoring, electrical appliances. Packaging, embroidery, weaving National Association for the Visually impaired. Foundation Blind, Sector-VI, R.K.Puram Secondary Secondary. Typewriting New Delhi 110 022. Prayas Institute for Juvenile Learning Justice, 59, Tughlakabad Disabilities OBE Foundation Library Attendant Secondary Institutional Area Sr. Secondary. House wiring Cutting & Tailoring Dress Making New Delhi 110 062. 4. Word Processing Sr. Govt. Laby Noyce Orthopaedically impaired. Secondary Beauty Culture Cutting & Tailoring Secondary School for the Deaf, Kotla Frozshah, Delhi Gate 5. New Delhi 110 002. Amar Jyoti Rehabilitation & Orthopaedic Handicap Research Centre, OBE Foundation Beauty Secondary Sr. Carpentry Secondary. Karkardooma, Vikas Marg Delhi 110 092. 6. 7 Culture Cutting & Tailoring Word Processing Learning Disability. Tammana Special School Learning D-6, Street, Vasant Vihar Disability New Delhi 110 057. Akshay Pratisthan , Vasant Multiple Disability OBE Foundation Bakery & Confectionary Cutting & Tailoring House Wiring Beauty Culture. OBE Foundation Carpentry, computer, Kunj, New Delhi weaving, block printing, art and craft, cutting tailoring, embroidery, beauty culture, packaging Source: A Handbook for Parents of Children with Disabilities, Planning CommissionEducation Department, GOI,2002. Rehabilitation Council of India, Status of Disability in India 2002 Ministry of Social Justice and Empowerment, GOI, Annual Report 2001-02 Employment Opportunities: Since 1977, Delhi Government establishments are providing 3% reservation for the disabled in respect of Group C' and Group D' posts. However after the enactment of the PWD Act- 1995, this reservation has not been so far extended to Group 'A' and B' posts due to non-identification of jobs falling under A and B groups. In the case of central government departments, identification of posts for persons with disabilities in all four groups has already been done in 1986. A committee was set up to modify the identification of posts in view of the PWD Act 1995. Identification of the posts has been completed. As per the order of government of India, reservation of 3% in jobs has been made in the identified posts for the physically handicapped persons in all the four Grades. Delhi government has made arrangements for special employment exchanges for the physically handicapped persons and the list of such persons are send to all government departments for providing job opportunities to them. The special employment exchanges are as follows: The Employment Special Employment Exchange for Barrack No. 1/ E Curzon Road,New Delhi 110001 Physically 5, Officer Handicapped Block A The Employment Special Employment Trans Yamuna,Delhi Physically Officer Handicapped Exchange for The National Center for Promotion of Employment for Disabled Persons (NCPEDP) a registered NGOs of Delhi is also helping physically impaired persons to seek employment in government and other private sector organizations. The organization has acted as a watchdog to bridge the gap for the implementation of all provisions of the PWD-Act 1995. The NGOs has been active in pressurizing government to identify the jobs in all four groups at the earliest and provide 3% reservations in such identified jobs to the deserving physically challenged persons. The organization has also conducted several research projects to pressurize the government and private sector for offering employment avenues to disabled persons. Promotion of Voluntary Action for Persons with Disability: The Ministry of Social Justice and Empowerment, Government of India has been actively promoting and strengthening voluntary action for welfare of persons with disabilities in the country. The main objective of the policy of the Ministry is to promote services for people with disability through non-government organizations so that persons with disability are encouraged to become functionally independent and productive members of the nation through opportunities of education, vocational training, medical rehabilitation, and socio-economic rehabilitation. Emphasis is also placed on coordination of services particularly those related to health, nutrition, education, science and technology, employment, sports, cultural, art and craft and welfare programs of various government and non-government organizations. These schemes provide financial support up to the extent of 90 per cent of the total project cost (up to 95 per cent for the rural areas), for recurring items like staff salary, maintenance charges, contingencies and non-recurring items like construction of the building. The major aim of the scheme is to provide financial assistance to NGOs for providing educational, vocational and social rehabilitation programmes. Thirty-six NGOs in Delhi were provided financial assistance during 2001-02. A total of Rupees 52.7 million, accounting 8.67% of the total support amount for the country under this scheme were disbursed to the NGOs for the voluntary action support to disabled persons during 200102 in Delhi. (Refer Table No. IV.2.3, depicting list of NGOs / Government centers supported by Ministry of Social Justice and Empowerment during 2001-2002) Table No. IV.2.3 DELHI NGOs Received Assistance under the scheme Promote Action For Persons with Disabilities 2001-2002 S. No. 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. 16. 17. 18. 19. 20. Organization AAROH, Vasant Enclave, New Delhi Akhil Bhartiya Natraheen Sangh, Raghubir Nagar, New Delhi Akshay Pratisthan, Vasant Kunj, New Delhi All Indian Confederation of the Blind, Institutional Areas, Rohini All India Federation of the Deaf, Sri Rka Marg, New Delhi All India Women's Conference, Bhagwandass Road, New Delhi Amar Jyoti Chritable Trust, Karkardopoma An Association For Scientific Research On the Addictions, Vasant Vihar, New Delhi Army Welfare Society, AG's Branch, Sena Bhawan, Hd, Qr, P.O., New Delhi-110011 Association For National Brotherhood For Social Welfare, Rohtak Road, New Delhi Astha ( Alternative Strategies for the Handicapped) ,Greater Kailash-II New Delhi Balvantray Mehta Vidya Bhawan, Greater Kailash-II New Delhi Bharatiya Blind Education Culture Welfare Society, Shahadra, Delhi-110032 Delhi Society for the Mentally Retarded Children, Okhla Dr. Zakir Hussain Memorial Society, Jamia Milia Islamia, Jamia Nagar Eclat Society for the Welfare of the Mentally Retarded, Sector 16 Rohini Eclat Society for the Welfare of the Mentally Retarded, Sector 16 Rohini Handicapped Welfare Women Association, Sector 14, Madhuban Chowk, Rohini Institution For the Blind, Amar Colony, Lajpat Nagar, New Delhi Institution For the Blind, Punchkuian Road, New Delhi Amount Received (In Lakh) 4.16 8.53 6.62 2.02 2.19 2.22 21.15 2.78 39.45 5.38 4.09 2.29 2.99 2.75 2.11 2.39 2.58 8.56 7.53 17.67 21. 22. 23. 24. 25. 26. 27. 28. 29. 30. 31. 32. Janata Adarsh Andh Vidyalaya, Sri Fort Road, Sadiq Nagar, New Delhi Janseva Abhed Ashram Charitable Society, 3, South Avenue Lane, New Delhi National Abilympic Association Of the India, Karkardooma National Association for the Blind Sector V R.K. Puram, New Delhi National Federation Of the Blind, 2721, Chowk Sanghtrashan, 2nd Floor, Pahar Ganj, New Delhi- 110055 Parents Association For the Welfare Of Children With Mental Handicapped, Muskaan, A-28, Haus Khas, New Delhi Rehabilitation Council Of India, 23-A Shivaji Marg, Near Karampura Complex, New Delhi-110015 Sanjivini, Society for Mental Health, A-6, Satsang Vihar Marg, Qutub Institutional Area, New Delhi Society For Child Development, 7-A, Commissioners Lane , Delhi-110054 Tamna, D-6 Street, Vasant Vihar, New Delhi-110057 The Blind Relief Association, Lal Bahadur Shastri Marg, New Delhi-110003 The Spastic Society Of Nothern India, 2, Balbir Saxena Marg, Haus Khas, New Delhi- 110016 Source: Annual ReportGovernment of India. 2001-02, Ministry of Social Justice 6.64 12.49 36.43 14.23 9.62 3.47 165.03 1.43 3.80 9.79 3.61 23.08 and Empowerment, Support for purchase of Aids and Appliances and other fitments: One of the important schemes of the Ministry of Social Justice and Empowerment, Government of India, is the scheme for Assistance to Disabled Persons for Purchase/Fitting of Aids & Appliances. The main objective of the scheme is to assist the needy disabled persons in procuring durable, sophisticated and scientifically manufactured modern standard aids and appliances which can promote their physical, social and psychological rehabilitation. Under this scheme 11 Government Organizations and NGOs were supported and 24.21 million rupees were provided to government and NGOs to support the purchase of aids and appliance and other fitments for the physically and mentally impaired persons in Delhi. (Refer Table No. IV.2.4) Table No. IV.2.4 Aids and Appliances Provided for Disability Sector in Delhi 2001-02 S.No Name of Organization Disability Type 1. Institute of Physically Handicapped Physically Handicapped 2. Akhil Bharti Viklang , basti Vikas Kendra, Physically Nand Nagri Handicapped Ortho Prosthetics Care & Rehabilitation, Physically Safdarjung Enclave, New Delhi Handicapped District Rehabilitation Center, IPH Multiple Disabilities. 3. 4. Amount Received (Rupees) 12,500,000 200,000 600,000 5,050,000 5. 6. 7 8 9 10 11 St. Stephen Hospital, Tis Hazari, Delhi Multiple Disability 1,663,000 All India Federation of the Deaf , Sri Ram Hearing Impaired 150,000 Krishna Ashram Marg, New Delhi Jyoti Manav Sewa Sansthan , Najafgarh, Multiple Disability 250,000 New Delhi Amarjyoti Charitable Trust, Karkardooma, Mentally Retarded 2,300,000 New Delhi and Physically Handicapped Akshay Paristhan , Vasant Kunj, New Delhi Multiple disability 500,000 Delhi Bharat Vikas Foundation, Viklang Orthopaedically 500,000 Sahitya Kendra , Dilshad Garden, Delhi Handicapped Indian Spinal Injury Center, Vasant Kunj, Orthopaedically 500,000 New Delhi Handicapped ALL 24,213,000 Source: A Handbook for Parents of Children with Disabilities, Planning CommissionEducation Department, GOI,2002. Rehabilitation Council of India, Status of Disability in India 2002 Ministry of Social Justice and Empowerment, GOI, Annual Report 2001-02 Concession and other Facilities available to Disabled in Delhi State: In order to ensure holistic approach to rehabilitation of persons with disabilities, the Delhi state government has provided various concession and facilities. These concessions and facilities are stated in Table No. IV.2. 5. Table No.IV.2.5 DELHI Concessions and Facilities provided to Disabled Persons By Delhi State Nature of Concession Employment Reservation and other Particulars State Government Jobs 3% in C and D category of Jobs Age Relaxation for Jobs Education Institutions 10 years age relaxation in jobs Reservation in all government Schools 3% Industrial Training Institutes 3% Other Reservations DDA Shops/ Kiosks 5% NDMC Stalls/ Kiosks 2% DDA Plots 1% Scholarship and Stipend Class I-V Rs. 50 per month Class VI-VII Rs. 70 per month Class IX-XII, Pre University/ I.A/ I.Sc Rs.125 for day scholar, Rs.300 for hostellers and Rs. 150 for readers allowance in case of visually impaired student. Rs.200 for day scholar, Rs.400 for hostellers and Rs. 200 for readers allowance in case of visually impaired student. Class B.A/ B.Sc/ B.Com Rs. 250 for day Scholar, Rs. 500 for hostellers and Rs.250 for readers allowance in case of visually impaired student Rs. 300 for day Scholar, Rs. 500 for hostellers and Rs.250 for readers allowance in case of visually impaired student B.E./B.Tech./MBBS/BDS/LL.B./B.ED./Dip.in Professional& Engg. Studies etc../In Plant Trg. M.A./M.Sc./M.Com./LL.M./M.Ed./MDS etc Disability Pension/Social Security Pension: Whose age is Above 55 years Unemployment Allowance Rs. 200/- P.M. Who is registered in employment exchange Conveyance Allowance: Rs. 50/- P.M. as an allowance Disabled Employees conveyance allowance @ 5% of their basic pay, Maximum up to Rs. 100/P.M. Free for Blind and 50% for escorts and Free traveling passes to physically handicapped persons Loan Scheme available Bus Concession Assistance for Self Employment Economic Assistance Disabled persons will get one time economic assistance Rs. 1000/- For Leprosy Patient T.B. Patients Rs. 400/- P.M Rs. 100/- P.M. Children of widow (For Education Material) Hostel Facility Exemption in Professional tax/road tax: Assistance for purchase of aids& appliances Rs. 250 to 400/- P.M. College going students will get free boarding, lodging, medical care, Scholarship, training, library facilities , tape recorder etc. Owner of motorized vehicle get exemption from paying road tax The physically handicapped persons given financial assistance for purchase. Source: Concessions/ Facilities available to disabled through state/ UT. Governments, Government of India, Ministry of Social Justice & Empowerment 1998. Barrier-Free Environment: Office of CCPD has brought out one manual containing guidelines for making barrier free environment (Planning a Barrier Free Environment) as a result of recommendations and access audits conducted by resource persons and participants during workshops in various parts of the country. Both the central government and Delhi government has made several efforts to provide barrier-free accessibility in major government institutions, public buildings, airport, railway stations, public parks, stadiums, SSC buildings, cinema halls and restaurants. However still a significant number of public places are not easily accessible to the disabled persons. Voluntary Sector Support for Disabled Persons in Delhi: Voluntary sector and registered non-governmental organizations are providing educational, healthcare, free aids and appliances, vocational training, counseling, guidance and rehabilitation in homes/ hostels services to physically and mentally impaired persons in Delhi. The support and services provided by voluntary and NGOs sector is vital and has been appreciated by beneficiaries, government and international agencies. Majority of the support and service activities are undertaken by NGOs sector with financial and technical contribution from government and international donor agencies. Disability India Network (DIN) web page[2], Concerned Action Now (CAN) a registered NGO of Delhi, Ministry of Social Justice and Empowerment, Government of India and Department of Social Welfare, Government of NCT of Delhi has identified several voluntary organizations and NGOs who provide services and other support to physically and mentally impaired persons in Delhi. CAN have published a booklet-providing list of NGOs and voluntary organization in Delhi, highlighting their target groups, mission, objectives and activities. List of the identified government organizations, voluntary organizations and NGOs associated with services for physically and mentally impaired persons in Delhi Metropolitan region was prepared by visiting government departments, NGO offices and through other sources like Ministry of Social Justice and Empowerment, DIN web page, CAN booklet etc. 136 government organizations and NGOs were identified, who were providing assistance to physically and mentally impaired persons in Delhi. (Refer Annex- IV.3.1) Sample Survey- Methodology: All the listed government organizations, NGOs and voluntary organizations were requested to supply information regarding their activities, manpower resources, infrastructure facilities and other relevant aspects. About 90% NGOs and government organizations responded to our request and furnished relevant information through post. An analysis of the details furnished by the government organizations and NGOs was undertaken. A sample of 83 government organizations, NGOs and voluntary organizations were selected for a detailed survey. (Refer Annex IV.3.2). Two sets of questionnaires were prepared for the purpose of a detailed sample survey. 1) Questionnaire for NGOs/ Voluntary/ Government organization. (Refer Annex IV.3.3) 2)Questionnaire for respondent physically and mentally impaired persons seeking services, support, counseling from the NGOs/ Voluntary/ Government organization. (Refer Annex- IV.3.4) A team of project staff was selected to conduct an in-depth interview of the organization's staff and their beneficiaries. The staff also collected and collated all available secondary sources of information from the offices of the NGOs, voluntary and government organizations. The methods adopted were field observation and respondents perception, group discussion and filling up of carefully prepared questionnaires from the stakeholders, participants and beneficiaries. Two Research Associates were selected to conduct the survey and collect relevant information from the selected representative sample consisting of organization staff and beneficiaries. Orientation training was imparted to the selected Research Associates and field workers with inputs from professionals and experts. (A weeklong training programme was conducted in Delhi for this purpose). The training provided to the staff was mainly to inculcate the skills of conducting quality interviews, develop a proper rapport with the NGOs staff and identify appropriate beneficiaries for the survey. A thorough exposition of how to observe relevant information from the field with vivid description of various situations was imparted to the selected staff in view of the objectives of the study. Wherever possible pictures and photographs were also undertaken in order to explain the existing situation. The selection of beneficiaries for the survey was based on the list of total beneficiaries and other staff/workers provided by the organization in the seminar. A total of 83 NGOs, voluntary/ government organizations and 63 beneficiaries were selected for a detailed primary survey. (Refer Annex- IV.3.2 and IV.3.5) A multi-level stratified sampling technique was applied to obtain a proper representative sample from each stratum. The criterion considered for selecting an appropriate representation of the beneficiaries in the sample survey were as follows: · Coverage of maximum geographical area by selecting NGOs, voluntary and government organizations and their beneficiaries located in different spatial areas within Delhi Metropolitan region. (Refer Map IV.3.1) · Coverage of beneficiaries from the organizations with different disability types. · Coverage of beneficiaries from all age/ sex and disability types groups. Organization of One-day Seminar: A one-day seminar on Services for Differently Abled Population In India was organized on 10th May 2003 at the India International Center, New Delhi to share the views of organizations serving disabled persons in Delhi. The major objectives of the seminar were as follows. (Refer Annex- IV.3.6 for outcomes of the seminar). Objectives: Objective of this seminar was to have a dialogue with government/ NGOs/ Civil society organization for effective implementation of the Disability ACT 1995 and its Rules 1995. The purpose is to seek information on services/ facilities and amenities required to provide equal opportunity without any discrimination to the disabled. The aim was to sensitize society and create awareness towards the responsibilities and duties for protecting human rights for the disabled population for their gainful employment and integration with the society. The Seminar seeks to: · Examine the magnitude and extent of different category of disabled population in India with special reference to National Capital Territory (NCT) of Delhi. · Evaluate demographic and social and economic profile of various categories of disabled population. · Identify the present service available for the different types of disabled populations in terms of institutions, community services, self-help groups etc in Delhi. · Evaluate the quality of infrastructure, manpower resource for guidance and training and technical support, infrastructure, counselling and equipments available in the centers for disseminating the identified services to the affected population. · Find out the gaps in the requirements and availability of services for the disabled population in the rehabilitation and other support centers. · Assess the impact of supportive services for creating suitable environment for better quality of life and opportunities for the disabled persons in social and economic sphere. · Prepare a set of recommendations for opening of services for the displaced population keeping in view the requirements of the area and to suggest improvements for present services in terms of staff training, curriculum development and purchase of equipments and other supportive programmes. Sample Coverage: The selected 83 NGOs, voluntary / government organizations represented all areas of Delhi Metropolitan region including Outer Delhi, Gurgaon, Faridabad and NOIDA areas. The organizations selected were in proportion to their presence in these areas. Accordingly 22% organizations were selected from South Delhi, 18% from Central Delhi, 16% from East Delhi, 12% from West Delhi, 11% from Outer Delhi and 1% each from Gurgaon, Faridabad and NOIDA. ( Refer Map No, IV.3.1) The link ed image cannot be display ed. The file may hav e been mov ed, renamed, or deleted. Verify that the link points to the correct file and location. The beneficiaries selected for the survey also represented different regions, so as to cover majority of organizations located in different areas. Twenty two percent, 19%, 10%, 10%, 9% and 8% were selected from South, Central, West, Outer Delhi, TransYamuna and North Delhi respectively. (Refer Table No. IV.3.1) Table No. IV.3.1 Delhi Metropolitan Region NGOs, Voluntary and Government Organization Surveyed March 2003- December 2003 S.NO Region Organizations 1 2 3 4 5 6 7 8 9 10 Beneficiaries North South East West Central Trans-Yamuna Outer Delhi Gurgaon Faridabad NOIDA ALL Organizations Beneficiaries Surveyed Surveyed Percentage Surveyed 7 18 13 10 15 8 9 1 1 1 83 8 22 16 12 18 10 11 1 1 1 100 5 14 8 6 12 6 6 2 2 2 63 8 22 13 10 19 9 10 3 3 3 100 Source: Sample Survey conducted in 2003. Disability Types Surveyed: The disability types served by the organizations covered for the survey, represented diverse groups. Several NGOs/ organizations were providing services and support to more than one disability groups. Majority of the organizations were serving locomotor impaired followed by mental retardation, visually impaired and speech & hearing impaired persons. About 10% organizations were covering multiple disability groups. Organizations serving other disabilities like cerebral palsy, autism, leprosy, slow learners etc; were few in numbers. The beneficiaries covered for the survey included persons having locomotor, mental, visual and speech & hearing impairment. Five percent slow learners were also covered for the survey. (Refer Table No. IV.3.2 and Fig. No. IV.3.1) Table No. IV.3.2 Delhi Metropolitan Region NGOs, Voluntary and Government Organization Surveyed Disability Types March 2003- December 2003 S.NO Organizations # 1 2 3 4 5 6 7 8 9 10 11 Disability Type Served Percentage Surveyed Beneficiaries Locomotor 72 Mental Retardation 70 Visual Impairment 70 Speech and hearing 67 Impairment Hearing Impairment 4 Cerebral Palsy 1 Multiple Disability 10 Dyslexia 1 Slow Learners 6 Autism 1 Leprosy and Others 24 ALL 29 19 29 14 5 3 1 100 The percentage of organizations surveyed need not add to 100 as organizations serve more than one disability type groups The link ed image cannot be display ed. The file may hav e been mov ed, renamed, or deleted. Verify that the link points to the correct file and location. Fig.No.IV.3.1 The link ed image cannot be display ed. The file may hav e been mov ed, renamed, or deleted. Verify that the link points to the correct file and location. Fig.NO.IV.3.2 Organization Status: The status of the organizations surveyed, depicts that majority of them (70%) were registered NGOs under the Registration Act of 1860. However a significant number of organizations were also private trusts and government and semi-government organizations. Majority of the organizations (95%) were old and were registered before 1995, while 7 organizations started providing services after 1995. (Refer Table No. IV.3.3 and Fig. No.IV.3.2) Table No. IV.3.3 Delhi Metropolitan Region Organization Status NGOs, Voluntary and Government Organization Surveyed March 2003- December 2003 S. No 1 2 3 4 5 6 Status of Organization Government Semi-Government Private Trust Charitable Registered NGOs Others ALL Percent 6 5 13 2 70 4 100 Source: Field sample survey. Children up to 18 years were major focus for service and support by majority of the organizations (80%). About 16% organizations also covered persons from all ages and 4% organizations covered disabled patients only for healthcare. The approach adopted for identification of target groups is usually inappropriate, as a significant number of beneficiaries had got the information through other beneficiaries only. Inappropriate publicity measures are in place hence awareness about the NGOs or organizations is lacking among the disabled persons. Beneficiaries were asked whether they were getting any support before seeking support from the present NGOs or organization. 97% of the beneficiaries were ignorant of the services being provided by such NGOs or organizations. They felt that a large number of impaired persons do not have any idea that such organizations exist. Thus these NGOs and organizations need to create awareness of their existence to benefit the target groups effectively. Services Provided: Majority of the NGOs/ organizations are providing special education for the impaired children only up to primary level. However no effort is being made to continue their education for higher-level education. Hence their retention rates are very low. A significant proportion of NGOs and other organizations are also providing vocational training mostly in tailoring and other low profile jobs. The skills imparted do not provide any viable source of income to the impaired person. Counseling and guidance for seeking support through the existing concessions and services from government schemes is provided by only 15% NGOs. This has helped several impaired persons to seek their due entitlement and create equal opportunity prospects for them. About 10% NGOs and other organizations provide aids and appliances to the impaired persons. These aids and appliances have been of great help in solving their basic handicaps especially for low vision and locomotor disability groups. Government funding under the aids and appliance scheme have been utilized by the NGOs for providing aids and appliances. Very few NGOs and other organizations are supporting quality skill development and self-employment generation programmes, which is the main requirement of the impaired persons. The Out Patient Department (OPD) for healthcare is also provided by very few NGOs and other government organizations. Thus the activities provided by the NGOs are not sufficient to alleviate their dependence on others. There is a need to extend schemes of healthcare, supply of aids and appliance and appropriate skill development programme for the impaired persons. Self-employment generating vocations are required to make impaired persons economically independent and provide them equal opportunities for becoming productive part of the society. Similarly impaired persons need to be provided higher education programmes through inclusive education system, so that the reservations provided in the PWD-Act 1995 are realized in its true letter and spirit. Availability of residential homes / hostels in the education institution for the impaired persons is minimal in view of the unfriendly accessible transport system to transport them for education purposes. Hence educational institutes and training ITIs must be provided with adequate hostel facilities to accommodate the impaired persons. This will go a long way in improving retention rates in the schools for higher education. A large number of impaired senior citizens also require residential homes as a significant number of them are living in the streets without any family or community support. (Refer Table No. IV.3.4) Table No. IV.3.4 Delhi Metropolitan Region Services Provided by NGOs, Voluntary and Government Organization Surveyed March 2003- December 2003 S. No 1 Services Provided Special Education (Day Boarding) Percent 67 Mid-day meals 3 2 2 3 4 5 6 7 8 9 10 11 12 13 Special Education (Residential) Education for Slow Learners Healthcare/ OPD services Aids and Appliances Counseling and Guidance Vocational Training 5 8 5 10 15 Tailoring 78 Music 67 Computer training 5 Others Out Reach Programme Advocacy Human Resource Development Sports Activities Rehabilitation in Homes/ Hostels Recreation Supporting Self-employment 10 5 3 5 6 5 4 2 Source: Field sample survey. Infrastructure and Manpower: Infrastructure in terms of building, healthcare, educational quality, quality of vocational training and availability of equipments were observed by the enumerators during the field survey. Ratings for the above facilities were allotted both by the enumerators as well as by the beneficiaries surveyed. Mean of the ratings given by the enumerators and the beneficiaries surveyed was worked to prepare final ratings for the above stated services in the organizations surveyed. Approach, accessibility and surroundings of the organizations surveyed were found conducive and appropriate as 75% NGOs and organizations were rated good and satisfactory in terms of approach, accessibility and surroundings. However space available for carrying out the services and other support programmes for the impaired persons was inappropriate for majority of the organizations surveyed. Only 41% organizations got good or satisfactory ratings for the space available for carrying their services satisfactorily. Healthcare support and services were provided only by 25% organizations, but majority of them had appropriate services for providing good or satisfactory healthcare. Most of these organizations were either private trust or supported by government or international donor agencies. The nature of educational quality provided by the NGOs and other organizations was not up to mark, as 22% organizations were rated poorly in terms of education quality. However a significant proportion of NGOs and other organizations were providing good or satisfactory quality of education up to primary level. Vocational training component was inappropriate and not conducive to provide selfemployment opportunities especially for earning decent income for self-sustenance. Most of the vocational training imparted was of low profile and basic, where beneficiaries had to face tough competitions from other population groups. Even marketing opportunities for products produced by the beneficiaries were not available. The organizations expressed their inability to provide quality skill training, as equipments were neither sufficient nor qualitative to impart quality skills. Lack of funds was major cause for not acquiring quality equipments. About 30% NGOs and other organizations had no equipments to provide training or healthcare support. Hence majority of them were engaged in providing counseling, referral services and guidance to the beneficiaries. The manpower available with the NGOs and other organizations was adequate to perform the services, which they have embarked upon but the quality and capacity building measures are lacking in majority of NGOs. About 43% of NGOs required immediate capacity building measures for their staff to get acquainted with the new techniques of dealing with the impaired persons. The government institutions train some of the staff but majority of the staff needs in-service training programmes to provide appropriate counseling, guidance and other referral guidance to the impaired persons. Thus infrastructure in the NGOs needs to be development in order to address to the concerns and requirements of the impaired persons. After proper assessment government may consider the specific NGOs for one-time grants to develop their infrastructure and manpower capacities. Beneficiaries have expressed their happiness for the services rendered by majority of the NGOs and they feel their support and service have definitely improved their capacity to deal with their disability appropriately. (Refer Table No. IV.3.5) Table No. IV.3.5 Delhi Metropolitan Region Available Infrastructure NGOs, Voluntary and Government Organization Surveyed March 2003- December 2003 Infrastructure Building Good Satisfactory Poor Nil Approach and Surroundings 58 17 25 Space 18 Healthcare 10 Education Quality 16 Vocational training quality 8 Availability of Equipments for training/ 25 healthcare Staff and Manpower 23 13 14 7 15 45 2 22 22 30 14 75 46 63 30 Professional and trained 27 25 43 5 Adequate to perform 56 26 10 8 Source: Field sample survey Support required by Beneficiaries and Organizations: Both beneficiaries and the NGOs and organization's staff were asked to spell their perception of requirements for the target groups. Results of the survey are depicted in Table No. IV.3.6. Table No. IV.3.6 Delhi Metropolitan Region Services required for disabled persons NGOs, Voluntary and Government Organization Surveyed March 2003- December 2003 S. No 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 Services Required Percentage Healthcare, supply of Aids and Appliances and 85 medicines Easy diagnostic and theruptic services 87 Separate OPD facilities 86 Residential facilities in schools for continuing 75 education especially for girls. Remedial free couching for disabled persons 65 Inclusive education for disabled after special schooling 45 in pre-primary/ primary level. Discriminatory attitude in education should be eliminated` Services for higher education, applied research and 58 technical education specially for impaired persons Interpretation support for blind persons 45 Translation recording facilities in schools 50 Computerized Braille press services 25 Special recreational programmes like dance music etc; 40 Friendly social atmosphere from community 70 Specialized vocational training which has easy market 75 availability Self-Employment or employment in government/ 80 private sector Equal opportunities in employment without any 68 prejudice against the disability Incentives to private sector for providing jobs to 80 disabled persons Financial support for self-employment at nominal 65 interest rates Out Reach programmes in villages 35 Transport services specially for impaired persons 65 Residential homes and free care for homeless disabled 85 persons Improvement in barrier-free accessibility in public 65 buildings/ parks/ education institutions and recreation theatres Income support in terms of regular pension to the 78 families whose bread earner is disabled Priorities in all poverty alleviation programmes 68 especially support to women. Dissemination of information through media. Press 85 and other methods regarding the government schemes and concessions for disabled persons. Source: Field survey conducted in 2003 The recommendations have been derived through the in depth survey, and deliberation from the One-day. These recommendations have been spelled in terms of enabling social, cultural and economic environment, strengthening government's pro active policies, healthcare, education, vocational training, employment opportunities and other referral and rehabilitation services. Details of the recommendations are given in Part-V of this report. Good Practice Initiatives by NGOs and other Organizations Good Practices Initiatives: The nature of activities and programmes and the scales of initiatives of government and non-government organizations were context specific, with varied scope, duration and geographical reach depending upon their mission and monetary allocations. The activities and programmes were both with direct governmental involvement as well as with involvement with partner agencies, NGOs and other voluntary organizations at regional levels. The strategies were mostly targeted towards: Community Awareness · Creating community awareness and sensitisation for disabled persons especially for most severely and handicapped persons. · Generating community acceptance of social and community support for rehabilitation and education initiative as an alternative for mitigating exclusion of disabled from society. · Promoting community involvement by developing partnership and participation with community for improving quality education, healthcare and vocational training for disabled persons. Education Related Strategies · Strengthening inclusive school education system through providing special attention to the disabled children in primary education through non-formal/ bridge course and other suitable methodology. · Reducing gender gap in education for disabled children and focusing on accelerated strategies for girl's education and guaranteeing their universal access to primary education. · Improving school educational infrastructure in terms of building, equipment to handle these challenged children and providing basic services in schools especially for slow learners and mentally challenged children. · Improving quality of education by providing teacher's training and identifying Minimum levels of Learning (MLLs) and developing appropriate curriculum, teaching-learning materials to impart the required MLLs to the physically and mentally challenged children. Rehabilitation of severely handicapped disabled persons: · Providing special rehabilitation support to persons having severe or profound degree of impairments. Poverty alleviation and Income Generation Strategies · Providing technical and vocational training to disabled persons to increase their income generation capacities. Administrative Capacity Building Strategies · Providing support for developing capacity building measures and skills to teachers, trainers and other staff associated with the services for disabled persons. Social Services and Health care Strategies · Promoting healthcare, through diagnostic and therapeutic services to children with developmental, socio-emotional, behavioral, learning, hearing, speech and language problems. Research and Documentation · Supporting research projects and other documentation initiatives to disseminate information to community and provide guidelines and help to policy-makers to prepare and develop appropriate strategy based on grass-root realities, results and impact assessment surveys. Some of the interventions undertaken by NGOs and government organizations located in Delhi have demonstrated very good models of innovative interventions at the local, regional and national level in implementing holistic developmental programmes for disabled persons. Some of these interventions have been documented in this report highlighting their objectives, coverage, process, impact and achievements. These interventions depict innovative approaches in addressing to the problems of disabled persons. The implementation of these innovative approaches seems to have made a difference and indicate prospects, if these interventions are pursued on a sustained basis and efforts are made to upscale them. However these interventions that have been documented and described are not necessarily being presented as models as no rigorous assessments have been made of the approaches and strategies used in these interventions. Hence these could be stated as good initiatives on providing support and services to disabled persons. Amar Jyoti Research and Rehabilitation Centre ( AJRRC): Amar Jyoti is a charitable organisation for the disabled and the other needy and marginalised groups. The institution provides comprehensive services in integrated education, medical care, speech therapy, physiotherapy and corrective surgery through a number of programmes like camps, counseling, teacher training and educational.The center was started with the aim of providing a ray of hope to people with special needs. The institute adopts holistic approach which includes awareness of parents, and provision of education, healthcare- social-psychological and physical, vocational training and job opportunities to the disabled persons. The organization has special educators, medical professionals, counselors, social workers and rehabilitation professionals who contribute in the developmental holistic programmes for the target groups. Medical Facility: Comprehensive medical units are an integral part of Amar Jyoti and the facilities are available to community as outpatient services. Services include Child guidance center, which has the services of Consultant Director, supplemented by a psychologist and a social counseling unit., day hospital, operation theatre, radiology, pathology, all therapeutic services including physio, occupational and speech therapy, audiology, prosthetics and orthotics, engineering and all psychological and counselling services. Routine hematological test like ESR, PCV, absolute eosinophil count, biochemical test like blood sugar, cholesterol, urea, bilirubin, serological test like RA factor, blood, widal, CRP, A.S.O., VDRL are performed in the Pathology laboratory besides the regular tests. Exchange programmes with foreign universities in the field of Physiotherapy, Speech Therapy and Occupational therapy are organised. Amar Jyoti also conducts a number of workshops and seminars in the field of rehabilitation every year to diffuse latest advances in technology in this field. Some of the topics for the workshops are assembly of mobility aids, vocational training, Physiotherapy unit, CBR and income generating schemes. Education Facility: The link ed image cannot be display ed. The file may hav e been mov ed, renamed, or deleted. Verify that the link points to the correct file and location. Amar Jyoti has developed child Based curriculum for these special children, which has been approved by the NCERT. The institution conducts classes from Nursery to Class XII as an integrated group of able bodied and children with disabilities who study together in batches. Five batches have been mainstreamed into good schools. The students, under special guidance, can pursue their studies and then take up their examinations under the National Open School for standards VIII, X and XII. These students can later apply for admission in various government and public schools. Every child at Amar Jyoti School with or without special needs is an equal learner. An integrated heterogeneous group of 540 children study together in equal number from Nursery to Class VIII. In addition to the recognition granted by the Delhi Administration to the middle school, The institute has the accreditation of the National Open School and IGNOU as special study centres. The School has a well-stocked library. It has audio-visual equipments, which effectively supplements student's knowledge about different subjects. It also has videocassettes of nearly all the milestone events of Amar Jyoti. The Vocational Training: Amar Jyoti provides comprehensive vocational training courses in HMT watch repairs, computer technology, fashion designing, textile designing, carpentry, knitting, stiching, screen-printing and art and craft. These community-based services are provided in 30 urban slums of Delhi. Efforts are also made to provided marketing opportunities for the products produced by the beneficiaries. Teacher's Training: The following programmes are conducted by the institution: · Teacher's Training course in special education for multiple disability recognised by the Rehabilitation Council of India. The link ed image cannot be display ed. The file may hav e been mov ed, renamed, or deleted. Verify that the link points to the correct file and location. · Foundation Training course for C.B.R. workers. · Internship for diploma holders in Physiotherapy and Occupational Therapy. Research and Publication: Regular research work is being promoted for meeting the challenges for advocacy. Several publications have been brought out towards dissemination of information for policy makers and public at large. These publications include CBR news, research papers, awareness materials, annual report etc; Akshay Pratishthan (AP): Akshay Pratisthan is a registered NGO working for rehabilitation of persons with disabilities through integrated education, medical care, vocational training and selfemployment avenues. It has also community our-reach programmes in 60 villages of Delhi and Rajasthan. The aims and objectives of the organization are: · To render rehabilitative services to persons with disability · To provide opportunities to persons with disability so that thay can lead a life of equality and dignity. · To promote mainstreaming of persons with disability · Early intervention in management of disabled children · To advocate rights of the disabled. Education: An integrated group of abled-bodied and disabled children study together in equal number from nursery to class VIII. Special attention is provided to physically challenged children to make them at par with other children. Futher education at class XXII level is affiliated to the National Open School. Healthcare: The healthcare programme includes physiotherapy, occupational therapy, medical specialist clinics, nature care and yoga, pranic healing Vocational Training: Vocational training is provided to disabled in carpentry, computer, weaving, block printing, cutting and tailoring, embroidery, durri making, masala grinding, packaging, electrical technicians, beauty culture and bakery and home sciences. Major Achievements: Some of the major achievements of the organization are awards for services in community rehabilitation, designing of hydraulically operated Tail Lift bus, effective placements of beneficiaries after vocational training and promotion of entrepreneurship among disabled through micro financing scheme of NHFDC. Publications: The organization publishes school magazines, annual dissemination of the information for the benefit of disabled persons. reports for Action for Ability Development and Inclusion ( ADDI) ADDI formerly known as the Spastics Society of Northern India (SSNI) aims · To challenge attitudinal, physical and information barriers which segregate people with disability · To facilitate equitable access to services and opportunities, especially in education, health, employment and other sectors. · To build security and stability for sustainable services for people with disabilities. ADDI provides special education, physical and functional therapy, speech and communication therapy, counselling, medical care, assistive devices, employment, legislation and advocacy and recreational services. Programmes and Activities of ADDI: The programmes and activities of ADDI include: · Centre for Special Education ( CSE): It provides children with disability ( 6-18 years) a sound learning environment to maximize their potential through appropriate services that support and facilitate inclusive education. · Home Management ( HM): The programme works to empower the parents and carers of people with disability to facilitate development and management of people with disability using their own resources. · Adult Training Centre (ATC): The training is provided both in the institution as well as in the community environment.The center provides disabled adults range of skills to optimally utilize their energies for production of goods and services and make them selfreliant. The center provides open employment in other institutions after imparting appropriate training skills. Self-employment is provided to trained disabled persons through soft loans. Sheltered employment is provided to severely and profound impaired persons. · Urban Community Based Rehabilitation (UCBR): Outreach programmes are conducted for disabled persons in the local urban communities, where awareness, OPD healthcare and other services are provided. · Rural Community Based Services (RCBR): Rural communities are covered for to create awareness for holistic development of disabled persons by integrating them into every aspects of community. It also helps people with disability to recognize their own potential, improve their quality of life and develop self-advocacy. · Resource Centre (RC): It has a resource center to train and support partner organizations in the field of disability and development. The school of rehabilitation science conducts regular training programmes and research activities. The center has organised several seminars and workshops. Asha Kiran (Home for Mentally Retarded) Department of Social Welfare, Government of N.C.T of Delhi. Asha Kiran is a complex for accommodating mentally challenged children and adults for their care, protection, maintenance, medical care and basic education and training. It accommodates separately both severely and profoundly as well as mildly and moderately retarded inmates. It has following complexes: · Custodial Home for 6-16 years Children: This home is meant exclusively for mentally retarded juveniles, which was established in the year 1961. It has a sanctioned capacity of admitting 100 mentally retarded juveniles of all categories. It is a custodial home and also serves as an Observation Home where destitute/neglected mentally retarded juveniles are admitted under the orders of Juvenile Welfare Board till they cease to be juveniles (Age group 6-16 years). The period of their stay cannot be extended beyond 18 years of age by the board. The inmates are provided with free boarding, lodging, medical care, special education and vocational training and occupational therapy facilities. · Children Aged 6-18 Years: This home was established in the year 1970 and has a sanctioned capacity of keeping 75 juveniles at a time. The destitute/neglected juveniles (mentally retarded girls, mild and moderate category) are admitted under the state protection under the orders of Juvenile Welfare Board till they cease to be juveniles (Age group 6-18 years). The period of stay cannot be extended beyond 20 years of age. After attaining the specified age the girls can be transferred to the adult section of this home. They are provided with free boarding, lodging, medical care, special education, vocational training and occupational therapy facilities. · Girls Home: This home was established in the year 1983 and has a sanctioned capacity of keeping 100 inmates (Mentally Retarded Girls). In this home destitute/ neglected juveniles (Age group 6-18 years, Severely and Profoundly Mentally Retarded Girls) are admitted under the state protection under the orders of Juvenile Welfare Board till they cease to be juveniles. The period of their stay cannot be extended beyond 20 years of age. After attaining the specified age the girls can be transferred to the adult section of this Home. Services: The services provided include preliminary teaching with the help of modern equipments and educational aids to the mild and moderately retarded. The classrooms have been furnished to suit the special requirements of the children. Training in paper craft, woodcraft, drawing and printing is provided according to the interest of the inmates. Mild and moderate inmates are provided prevocational & vocational training in various trades suitable to their capacity. Training facilities are available in cutting and tailoring, knitting, chalk making, candle making, card board box making and ball pen refill making. Occupational therapy is provided to the inmates suffering from physical handicaps. IT provides evaluation and therapeutic management for neuromuscular, orthopaedic, masculo-skeletal and cognitive disabilities. Special medical care is being taken for the inmates. Psychological assessment of intelligence (I.Q) is conducted through various tests in a well equipped Psychological laboratory. It also provides counselling for behavior problems both for parents of the disabled as well as for the inmates. Periodic meeting of the parents is held to discuss their progress. The Home has all modern recreational facilities, which includes regular picnics, excursions and other out door ventures. National Association for the Blind (NAB): NAB Delhi branch is a registered society founded in April 1979 with the mission to empower blind people and work towards the integration and mainstreaming of the visually impaired. The primary objective of the organization is the education of the visually impaired children. The major thrust of the association is the integrated education of persons with visual impairment in normal schools. NAB Delhi offers hostel facilities and extra coaching facilities to blind students studying in 26 general schools in Delhi. Young blind children in the age group of 4-14 are trained in the preparatory unit where they are exposed to orientation & mobility, activities of daily living, art & craft, besides academics. In addition to these there is a multi-handicapped Unit where children having visual impairment and additional disabilities receive training in sensory integration, orientation and mobility, activities of daily living and functional academics. Major Activities: ·Preparatory School for blind: Blind children of 4-14 years are admitted in boarding school at the institution in R.K. Puram free of cost . They are taught regular curriculum along with training in language (oral, reading and writing), activities of daily living, environment information and object perception, orientation and mobility, physical fitness and recreation. Specially trained teachers are employed to develop talents among the children. · Integrated Education: Students completing primary and middle level education from the organization are enrolled in private and government schools in Delhi for inclusive and integrated education. Transport facilities are made available to transport them from organization to the schools. · Center for multi-handicapped blind children: A special school provides special educational needs for the multiple- handicapped blind children. Professional trainers are employed to teach these children. · Hostel Facility: All the children enrolled in preparatory, integrated and multihandicapped centers are provided free lodging, boarding, transportation, medical care and recreational facilities · Computer Training Center: NAB has computer work stations with all modern facilities like Braille printing machines, decoders etc; The students undergo training for Windows, word processing, internet, e.mail, spread sheets with help of computer attached with speech synthesizers. · Employment and Placement Services: NAB provides career counselling and assist the blind to get employment in their appropriate fields in private, public and government undertakings. · Braille and large print services: An in house mini computerized Braille press publishes textbooks and literature of general interest in English and Hindi for the students and other blind and low vision persons. These books are kept in the library for the use of target groups. The organization has talking book library where audio cassettes of several books are recorded for the benefit of visually impaired persons · Prevention of Blindness: NAB also organizes out reach camps and undertakes free and subsidized eye treatment, cataract surgery, spectacles distribution, eye check-up and awareness generation. · Services for Elderly Blind: NAB has home for elderly blind men and women. They are provided comfortable living conditions free of cost. Institute for the Blind: The Institution for the Blind aims at integrating the blind population with the general population by equipping them with such training in cottage industry as would enable them to gain a reasonable degree of economic independence. The Institution is operating two schools one at Panchkuan Road and other at Amar Colony, Lajpat Nagar for blind children in Delhi. The target group is 7-15 years. All modern basic amenities are available in both the schools. Education is given up tyo class VIII as per the prescribed syllabus of the Education Department, Delhi Government. The institution is also providing free vocational training in music, canning and candle making. The organization has well developed library, Braille printer etc. Vocational Rehabilitation Centre for the Handicapped (VRC), IIT Campus, Pusa Road: The Ministry of Labour, Government of India has stabled 11 VRCs throughpur the country for providing vocational skills to disabled persons. VRC, Pusa Road targets all multiple disabled persons. Major aims and objectives are: · Evaluation and assessment of impairment and identification of appropriate vocational skill for the disabled. · Vocational counselling and guidance for parents and disabled persons · Skill development programme, placement services, support and community extension services. · Coordination with other agencies within the jurisdiction of Delhi and Haryana and help with self-employment. The Center provides non formal training in the areas of secretarial practice, radio and T.V. mechanics, coil winding, servicing of electronic equipment, auto repair, typesetting and book binding. National Centre for Promotion of Employment for Disabled People (NCPEDP): The NCPEDP is a non-profit organization working as an interface between government, industry, international agencies and the voluntary sectors towards increased employment opportunities for disabled people. The organization helps to find employment opportunities for disabled persons, in addition to conducting workshops and seminars for creating awareness of employment opportunities. They are also involved in advocacy of employment opportunities and rights of disabled persons. Scholarship programmes for post graduation of the disabled are initiated. Research studies are conducted to create better opportunities for them. Tamana Association: The organization works for mentally impaired children and children suffering from autism. It aims at spreading awareness about disability in addition to legal advocacy about the same. It has special programmes for special education, vocational training, rehabilitation and counselling. It has a day-boarding school for the target groups. Academic programmes include speech therapy, mobility skills development, physical development, self help skills; occupational therapy and vocational training programmes; It also provides Home Training Programme deals with children above six years and adults. It has counseling and training modules for the parents. Family of Disabled (FOD) Family of Disabled (FOD) is an NGO based in Delhi that works with people with disabilities at all levels of society. Objectives: · To enable people with disabilities become self-reliant, productive and independent individuals. · To support, motivate and encourage them to face challenges. · To create awareness and sensitize masses about various aspects of different disabilities. FOD supports people with disabilities and their caretakers, and helps create awareness about special needs of this population through a publication and through regular art exhibitions. FOD works with the poorest disabled persons in slum areas in Delhi. FOD helps disabled with APNA ROZGAR programme. Entrepreneurs with a variety of disabilities run tea stalls and rickshaw businesses, make candles, and repair electrical goods. FOD also offers one-on-one counseling and mentoring. FOD also provides aids and gadgets to those in need through other organizations. It published a news magazine The Voice of FOD' to generate awareness and fill the void resulting from absence of material on disability. Conclusions and Recommendations Conclusions: The broad conclusions of the study are as follows: · Defining disability is difficult to accommodate the expectations of all disabled groups. There are hundreds of different disabilities and there are, as many causes for these disabilities. Some people are born with disabilities; others become disabled later on in their lives. Some disabilities exhibit themselves only periodically like fits and seizures; others are constant conditions and are life-long. The severity of some stays the same, while others get progressively worse like muscular dystrophy and cystic fibrosis. Some are hidden and not obvious like epilepsy or haemophilia (impairment of blood clotting mechanism). Some disabilities can be controlled and cured while others still baffle the experts. Thus, finding a consensus on the different and frequently varying definitions of disabilities, whether sophisticated or practical, has never been easy. Some include total or partial impairment of senses and physical and intellectual capacities while defining disability. Others refer to a handicap or deviation of a social nature, injury or illness or incapacities to accomplish physiological functions or to obtain or keep employment. These definitions also reflect the consequences for the individual cultural, social, economic and environmental- that stem from the disability. · Disabled people do not form a homogenous group. They may be, the physically disabled, mentally retarded, the visually, hearing and speech impaired, those with restricted mobility or with so-called "medical disabilities" and learning disabilities. They can broadly be classified as Physical and Communication, Mental, Learning and Medical disabilities. · The World programme of Action Concerning Disabled Persons have specified preventive, rehabilitation and equalization of opportunities actions for disabled persons, keeping in view the founding principles of the UN Charter, which are based on human rights, fundamental freedoms and equality of all human beings. It has suggested propagating social model through equalisation of opportunities through which the general system of society, such as the physical and cultural environment, housing and transportation, social and health services, educational and work opportunities, cultural and social life, including sports and recreational facilities, are made accessible to all. Equalization relates to the process of building a suitable environment to reasonably accommodate those needs of disabled persons. · India has taken a big leap towards providing equalization of opportunities for disabled by adopting PWD-Act 1995. It is a significant step, which ensures equal opportunities for the people with disabilities and their full participation in the nation building. The Act provides for both the preventive and promotional aspects of rehabilitation like education, employment and vocational training, reservation, research and manpower development, creation of barrier-free environment, rehabilitation of persons with disability, unemployment allowance for the disabled, special insurance scheme for the disabled employees and establishment of homes for persons with severe disability etc. · The NSSO 58th round has estimated 18.49 million disabled persons in 2002, out of these 10.89 million were males and 7.59 million were females. About 57.50% disabled were having locomotor disability, while 10.88% were blind, 4.39% were having low vision, 16.55% were having hearing impairment, 11.65% had speech disability, 5.37% were mentally retarded and 5.95% were mentally ill. · The prevalence rate was 1.77% in 2002 against 1.88% in 1991. The prevalence rate for males was 2% while it was 1.49% for females in 2002. Prevalence rates have shown declining trends during 1991-2002 for all disability types except for locomotor disability. Significant decline was registered for visually impaired persons during 1991-2002 · The decline of prevalence rates for disabled persons among all disability types in age groups of less than 15 years and above 45 years is a welcome measure depicting appropriate awareness and medical care support. But increasing trends of prevalence rates for 15-44 age groups especially for locomotor impairment is a cause for worry and needs to be studied in-depth. A significant proportion of disabled persons were in the active working age group of 15-59 years especially among locomotor impaired, making not only themselves but their families also susceptible to social and economic uncertainties. Incidence rates has depicted significant declining trends during 19912002 for all types of disability groups in lower and high age groups due to appropriate preventive measures like awareness generation and medical care support, but increasing incidence rate during 1991-2002 among the age groups of 15-29 years for locomotor impaired persons needs further in-depth analysis. · Fortunately about 60% disabled can function without aid/ appliances, while 13% cannot function even with aid and appliance and another 17% can take self care with the help of aid and appliance. Significantly 10% disabled have neither tried nor have access to aids and appliance and hence cannot take self-care. Thus measures need to be taken through the supply of appropriate aids and appliances to cover these 10% disabled, so as to reduce their dependence on other · As expected significant proportion of disabled were from scheduled castes, scheduled tribes and other backward classes. These groups require special attention through specific programmes to create awareness and support them through appropriate medical care and other rehabilitative measures. The social structure of disabled indicates that majority of them are never married or widowed/ divorced. Hence community support is required to rehabilitate them. A significant proportion is living with parents without spouses. Hence social security measures from government or community needs to be strengthened to support them in the later ages. · The education level of disabled persons as compared to the general population trends depicts gloomy and depressing situation as about 59% disabled persons in rural areas and 40% disabled persons in urban areas were illiterate. Even among disabled literates, a significant proportion was educated only up to primary or middle level both in rural and urban areas. Provision of vocational training to the disabled person has yet to gain momentum as only 1.5% and 3.6% disabled population in rural and urban areas respectively had received vocational training in 2002. The educational scenario depicts that majority of disabled persons are not provided equal opportunities for education and even few who are enrolled in schools are not provided equal opportunity for middle, secondary and higher education. · The NSSO survey 58th round in 2002, depicts that 62% and 89% males and females respectively in rural areas and 63.5% and 90.5% males and females respectively in urban areas were out of labour force. A distressing scenario for disabled persons depicts decline in proportion of self-employed in non-agricultural sectors in urban areas and in agricultural sector in rural areas during 1991-2002. Even the proportion of casual employees has declined during 1991-2002 for both rural and urban areas. · The loss of job or change of job is one of the major psychological and mental problems associated with the onset of disability. Significantly 55.8% and 53.1% of these working people lost their job after the disability in rural and urban areas respectively. Another 13.2% in both rural and urban areas had to change their job due to the onset of the disability. Only 30.9% and 33.6% disabled persons continued with their jobs even after the onset of disability in rural and urban areas respectively. o In consonance with the policy of providing a complete package of welfare services to disabled and handicapped individuals and groups, the Central government have set up national institutes along with their respective regional centres in each of the major area of disability. The thrust areas of these national institutes are development of manpower and of delivery models of services, which can have a widespread reach in the population. These institutes are: National Institute of Visually Handicapped (NIVH), National Institute of the Hearing Handicapped (NIHH), National Institute for Orthopaedically Handicapped (NIOH), National Institute for Mentally Handicapped (NIMH), The Institute for the Physically Handicapped (IPH) and National Institute of Research, Training and Rehabilitation (NIRTAR). These institutes run various specialized courses to train professional in the different areas of disabilities. These Institutes also run Out Patient Departments (OPD) clinics, which include diagnostic, therapeutic and remedial services. They also provide educational, pre-school and vocational services. These institutes have started outreach programmes with multi-professional rehabilitation services to the slums, tribal belts, foot hills, semi-urban and rural areas through community awareness programmes and community based rehabilitation facilities and services such as diagnostic, fitment and rehabilitation camps and o o o distribution of aids and appliances to the disabled. Through outreach services, communities are sensitized on early-identification, prevention, intervention and rehabilitation of the disabled. Services such as vocational training and placement are provided in collaboration with NGOs. Technical know-how and information are also provided to NGOs, on infrastructure requirement for established service centers for the disabled. Government of India has developed several national, regional and district levels support centers to provide effective services to meet their requirements for aids and appliances, education, training and employments and other appropriate rehabilitation services. These macro, meso and micro level centres are located throughout the country to provide services at macro, meso and micro regional levels. The centers are Artificial Limb Manufacturing Corporation of India (ALIMCO), Indian Spinal Injury Center (ISIC), National Information Center on Disability and Rehabilitation (NICDR), Composite Regional Centers (CRC, Regional Rehabilitation Training Centers ( RRTCs), Vocational Rehabilitation Centers (VRCs), District Rehabilitation Centers ( DRCs). Specific funds have been allocated by the central government to these institutes and voluntary sector to support disabled persons. Both state and central Government has also provided Concessions and other facilities to disabled persons. The concessions and facilities include scheme of Integrated Education, scholarships and fellowships for education and vocational training, job reservation in Government Sector, economic assistance for disabled persons and other welfare measures like rebate in income tax, loans at soft interest rates, travel concession and specific poverty alleviation programmes for disabled persons. The implementation status of the PWD-Act 1995 has been analyzed and significant measures have been adopted by central government as well as by several state governments to implement the important provisions of the Act. However several state governments are still lagging behind in implementing these provisions. · Based on the sample data collected by the NSSO 58th round, an estimated 77, 046 persons were projected as disabled persons, who were having at least one of the impairments in term of mental, vision, speech, hearing and locomotor disability. The gender distribution of disabled persons was 52,239 males and 24,102 females constituting 68% and 32% males and females respectively. Majority of the disabled persons (70.43%) were locomotor impaired followed by mentally retarded (7.70%), speech impaired (7.69%), hearing impaired (7%), mentally ill (6.24%), blind (5.26%) and low vision (2.14). The prevalence rates were 0.55%, while it was 0.69% for males and 0.38% for females. · The disability incidence rates were very low in Delhi as compared to the national average, depicting appropriate measures like awareness and medical care support for taking preventive measures for controlling disability. · Fortunately about 51.5% of the disabled can function without aid/ appliances, while 20.9% cannot function even with aid and appliance and another 21.3% can take selfcare with the help of aid and appliance. Significantly 6.3% of the disabled have neither tried nor have access to aids and appliance and hence cannot take self-care in case of urban areas. Thus as compared to the national average aids and appliances have been provided to a majority of the disabled person · As expected less proportion of illiterates were found among the disabled persons in Delhi as compared to the national average, as only about 24% disabled persons were illiterate in Delhi. But surprisingly contrary to the expectations illiteracy rate among the disabled was 14.8% in rural areas and 27.8% in urban areas. This could be attributed to the presence of disabled person in slum colonies, who have migrated from rural areas and their families push the disabled children for begging and other low profile jobs. Even among the disabled literates 30% have education up to primary level, while 18% and 27% disabled persons were educated up to middle and secondary and above secondary level respectively. Thus in spite of propagation of inclusive education for disabled in the normal schools and availability of a large number of institutional services through NGOs and other governmental organizations for education of disabled persons, the educational levels for disabled persons in Delhi are still poor and need immediate support and strengthening. · Only 9.9% disabled population had attended vocational training in Delhi state in 2002. Even among the disabled persons who received the vocational training, the nature of training received was in non-engineering skills, which fetch lower profile jobs and have lower income generation prospects. Thus majority of them lacked earning capacity through the training provided to them. Only 1.2% disabled persons had received vocational training in engineering skills. Thus the position of vocational training even in Delhi the capital city with numbers of government and nongovernment institutions for disabled persons is pathetic and needs immediate attention of policy makers. The PWD-Act 1995 has not changed the scenario of job opportunities for the disabled inspite of reservations. · A number of voluntary organizations, NGOs and government organizations are providing technical training for developing capacities of human resources to attend the needs and requirements of the disabled persons in Delhi. These organizations also provide educational, referral, healthcare, vocational and rehabilitation support in Delhi. Thirty-six NGOs in Delhi were provided financial assistance during 2001-02. A total of 52.7 million Rupees, accounting 8.67% of the total support amount for the country under this scheme were disbursed to the NGOs for the voluntary action support to disabled persons during 2001-02. 11 Government Organizations and NGOs were supported and 24.21 million rupees were provided to government organizations and NGOs to support the purchase of aids and appliance and other fitments for the physically and mentally impaired persons in Delhi. Several concessions have also been provided by Delhi government in terms of educational reservation, job reservation in C and D groups, preferences for allotment of land and houses etc; · The analysis of field survey data collected from 83 surveyed NGOs and government organisations has revealed that majority of the NGOs/ organizations are providing special education for the impaired children only up to primary level. However no effort is being made to continue their education for higher-level education. Hence their retention rates are very low. A significant proportion of NGOs and other organizations are also providing vocational training mostly in tailoring and other low profile jobs. The skills imparted do not provide any viable source of income to the impaired person. Counselling and guidance for seeking support through the existing concessions and services from government schemes is provided by only 15% NGOs. Very few NGOs and other organizations are supporting quality skill development and self-employment generation programmes, which is the main requirement of the impaired persons. The Out Patient Department (OPD) for healthcare is also provided by very few NGOs and other government organizations. Only about 10% NGOs and other organizations provide aids and appliances to the impaired persons. These aids and appliances have been of great help in solving their basic handicaps especially for low vision and locomotor disability groups. · Thus the activities provided by the NGOs are not sufficient to alleviate their dependence on others. There is a need to extend schemes of healthcare, supply of aids and appliance and appropriate skill development programme for the impaired persons. Self-employment generating vocations are required to make impaired persons economically independent and provide them equal opportunities for becoming productive part of the society. Similarly impaired persons need to be provided higher education programmes through inclusive education system, so that the reservations provided in the PWD-Act 1995 are realized in its true letter and spirit. Availability of residential homes / hostels in the education institution for the impaired persons is minimal in view of the unfriendly accessible transport system to transport them for education purposes. · The infrastructure and quality of services provided by the surveyed organizations depicts building infrastructure and space was not appropriate to provide effective services to the disabled persons. Healthcare support was provided only by few organizations. · The nature of educational quality provided by the NGOs and other organizations was not up to mark, as 22% organizations were rates poorly in terms of education quality. However a significant proportion of NGOs and other organizations were providing good or satisfactory quality of education up to primary level. · Vocational training component was inappropriate and not conducive to provide selfemployment opportunities especially for earning decent income for self-sustenance. Most of the vocational training imparted was of low profile and basic, where beneficiaries had to face tough competitions from other population groups. Even marketing opportunities for products produced by the beneficiaries were not available. The organizations expressed their inability to provide quality skill training, as equipments were neither sufficient nor qualitative to impart quality skills. Lack of funds was major cause for not acquiring quality equipments. About 30% NGOs and other organizations had no equipments to provide training or healthcare support. Hence majority of them were engaged in providing counselling, referral services and guidance to the beneficiaries. Recommendations: The recommendations derived from the in depth field survey and analysis of the information collected through literature survey and other study's are spelled in terms of enabling social, cultural and economic environment, strengthening government's pro active policies, healthcare, education, vocational training, employment opportunities and other referral and rehabilitation services. Enabling social, cultural and economic Environment: Establish responsibility on the society to make adjustments for disabled people so that they overcome various practical, psychological and social hurdles created by their disability. Provisions to ensure equal opportunities without discrimination to all disabled people in Employment and protection of rights and full participation of disabled people in mainstream activities of the society. Responsibility to prevent disabilities, provision of medical care, education, training, employment and rehabilitation of persons with disabilities. Creating barrier-free environment for them, remove any discrimination against them which prevents them from sharing the development benefits, counteract any abuse or exploitation, lay down strategies for comprehensive development of programmes and services and for equalisation of opportunities. Collective efforts must be made by the entire society to integrate disabled with society for social contacts and participation in leisure and recreational activities. Strengthening Government's pro-active policies: Government of India must undertake revision for identification of job list for disabled population for 3% reservation in government and PSUs, keeping in view the spirit of elimination of negative jobs for disabled rather than identifying positive jobs for disabled. The Committee for job identification list should include people from all walks of life including the disabled and pragmatic approach must be adopted for identifying job list. More categories of disability must be included in the Act for provision of reservation benefits especially mentally disabled, autism, hemophilia and Alzneimer's disease etc. The Disability Act 1995 and its Rules 1996 must be translated into all regional languages, so that its various provisions, benefits, etc. become widely known. Coverage in programmes must be increased in the electronic and print media, which promote positive attitude towards persons with disability. Dissemination of information through media. Press and other methods regarding the government schemes and concessions provided for disabled persons. Healthcare · Establishment of Child Guidance Centers, to develop community understanding and support for children. · Free OPD facilities at all major government and private hospitals for disabled persons. · Supply of free aids and appliances after appropriate medical check-up in all government and private hospitals. · Supply of free medicines for disabled persons in all major hospitals. · Improved equipments and professional manpower in centers for comprehensive diagnostic and therapeutic services to disabled especially children. · Diagnostic and therapeutic services to children with developmental, socio-emotional, behavioral, learning, hearing, speech and language problems. . Early intervention for minor impairments should be made mandatory through hospital services for prevention of these impairments turning into chronic impairment cases later. Education · Residential facilities in majority of schools for disabled especially for girls for maintaining their retention rates in view of difficulties in travel to schools. . Counselors who can provide S.I therapy should be appointed in all schools (government and private) to identify learning disabilities among the school-going children. Curriculum for mentally disabled or learners with disability must be made appropriate and tailor-made to reduce their stress. . Develop school-based programme aimed at assisting disadvantaged pupils and to mitigate conditions that hinder their learning. · All facilities like readers and translator's services and computerized Braille printing should be made available for blind persons. · Remedial free couching after school hours by specialized and trained professionals to make children up to date with other school children. · Inclusive education of severely disabled persons should be given only after professionals at pre-primary or up to primary stage give specialized training to them. Discriminatory attitude in the inclusive schools should be eliminated. · Developing the potential of children with disabilities through integrated education, cultural and sports activities. · Facilities and services should be improved and strengthened for enabling impaired person to continue for higher education, applied research programmes and technical education. · Disability should be taught as a separate discipline in the colleges and Universities with an integrated multi-disciplinary approach. · Appropriate financial, technical, human resource and infrastructure support should be made available through centre and state funds for education, technical and professional training for children and adults with disabilities throughout the length and breadth of the country. Identification of such target groups should be conducted at micro levels through field surveys. Equal Opportunities for Employment Regular promotions without positive discrimination to disabled staff in government and PSUs to next grade should be given in time. Immediate adoption of Incentive policy for providing incentives to private sector for promoting employment of disabled. Employment of disabled should be made mandatory for the organizations supported by government funding. Private sector should be encouraged and sensitized to provide equal opportunities without positive discrimination to disabled population through persuasion, awareness and pressure lobby. Government of India should accord priority to poor persons with disabilities in all poverty alleviation programmes. Sheltered employment for severely and profoundly impaired persons should be ensured by NGOs, private sectors as well as government jobs. · Adoption and Ratification of ILO Convention No.159 and Recommendation No. 168 related to Vocational Rehabilitation and Employment of disabled persons. Vocational Skills · Increase in the vocational training centers exclusively for the impaired persons. These vocational centers should be manned with professional trainers. · Vocational skills should develop capacity building to generate higher income earning capacities. Skills should be provided for manufacturing products having marketing opportunities. · Improved technological equipments should be made easily accessible to impaired persons, to improve their efficiency without physical and health discomfort while learning the vocational skills. · Easy access of loan at lowest interest rates for disabled especially for women for encouraging self-employment entrepreneurship. Their self-employments schemes must be monitored and sheltered with support from government and civil society agencies. Marketing of the product should be supported by civil society and government organization. Barrier-free Accessibility · All major public places, educational institutions, parks, railway stations, bus stands, airports, hospitals, hotels should adhere to the building code Act to provide easy and enabling accessibility for the impaired persons. · Transport services at concessional rates exclusively for the impaired persons should be strengthened to make easy mobility for travel for impaired persons. Rehabilitation Homes · Community based rehabilitation programmes should be encouraged for the disabled persons · All homeless impaired persons should be identified and provided free residential homes/ hostels with all facilities minimal living facilities. Pension to these homeless impaired persons should be enhanced. · Income support in terms of regular pension to the families whose bread earner is disabled. References and Bibliography Bibliography, References and Literature Reviewed Abidi, Javed: 1995, No Pity. 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Major Activities: · Advocacy with, for and by people with disabilities. · Collectiuon and dissemination of information related to disability · Participative action research using Action Learning as an approach and technique. · Consultation, referrals, counselling and networking · Training, orientation programmes and generating awareness. Maximizing Employment to Serve the Handicapped (MESH): MESH, enables the handicapped (Leprosy cured or Leprosy Patients ) to earn their own living and gain dignity as human beings. MESH focuses on two areas of production: the weaving of handloom cloth and the raising of broiler chickens. The first handloom projects started in India in Bethany Village, near Delhi in 1964, thanks to the efforts and commitment of many volunteers. By 1981, the projects had expanded to include two additional communities, Anandgram and Amarjothi. A permanent organization was needed to coordinate village projects and act as a liaison between the rehabilitated leprosy patients and the distribution market and MESH was created. MESH works directly with four colonies in the region of Delhi: Bethany Village and Amarjothi in Haryana, Anandgram, across the Jumma River, in Shahdara, and Barat Mata Kusht Ashram in Faridabad. MESH offers first quality handloom items, which include tablecloths (with or without napkins), placemats, tea towels, oven mitts, bedspreads, bed sheets, pillowcases, floor swabs, woodcarvings and other household articles. Major goals of MESH are : Provide opportunities for former leprosy patients - regardless of race, colour, caste, or religion - to be rehabilitated in order to support themselves Train or retrain the disabled to produce goods suited to their capabilities Guide in the selection of what will be marketable items Assist in obtaining the raw materials needed, such as quality yarns and colourfast dyes for the handloom projects, healthy chicks and quality feed for the poultry projects Maintain quality control Transport products from villages to Delhi Pay promptly for goods and services received, maintaining a constant cash flow to ensure salary payments to leprosy patients and working capital for continued production Guide the village industries in preparing cost sheets to include fair wages for workers as well as a percentage for overhead costs and profits Secure orders with the aim of providing full-time employment for the rehabilitated leprosy patients. Sl. No 1. Area Name of NGO Locality Activity West Delhi Areas AALAM Hari Nagar 2. West Delhi Areas Abhilasha Special Mayapuri Education Centre 3. West Delhi Areas Asha Awwa School Cantonment for Handicapped Children 4. West Delhi Areas West Delhi Areas Asra (Action for Vikaspuri self Reliance and Alternative Inspiration Vikas Puri 6. West Delhi Areas Awaag School 7. West Delhi Areas West Delhi Areas Family of Disabled Janakpuri West Delhi Areas West Delhi Areas Society for child Shashtri Nagar Development Prabhat School Training Cum Punjabi Bagh Production Centre West Delhi Areas West Delhi Areas Perfect Foundation Palam Colony School Formal and informal Multiple Education, Vocational Disability Training, Rehabilitation and coaching center for disabled children Individualized Education, Mentally ill, Speech therapy and audio Hearing assessment and referral impaired services Academics for hearing Mentally impaired for mentally Retarded and retarded from five to 14 hearing impaired years of age Computer Education for 10 Orthopaedically th and 12 students handicapped physically handicapped Day Care activity Mentally ill, Counseling, Sports, Multiple Disability, Vocational Training etc. Spastic. Speech Therapy, Special Hearing Education for deaf and Impaired mentally retarded children 3 to 18 years Promoting artists, Economic Multiple independence, creation and Disability leisure activities BRAC Model non- formal Children (Under Primary Education, privileged) Vocational Training and need based programme CO- educational primary Mentally ill school for slow learner and mentally ill Training Cum Production Mentally ill Centre for the handicapped in the age group 18 years and above Co- educational primary day Orthopaedically school in the age group of 3 handicapped to 10 years Evaluation and Assessment Multiple Vocational Counseling and Disability Guide ness for parents and 5. 8. 9. 10. 11. 12. Special Kirti Nagar Samarath professionals Vocational Rehabilitation Centre the Tagore Garden Pusa for Focus Area handicapped Aasha Kiran Rohini 13. North Delhi Areas 14. North Delhi Areas All India Rohini Confederation of the blind 15. North Delhi Areas 16. North Delhi Areas Handicapped Rohini Women's welfare Association, School for the Handicapped The Eciat Society Rohini for mentally Retarded 17. North Delhi Areas Handicapped Shalimar Bagh women's welfare Association 18. North Delhi Areas Manovikas Kendra Ashok vihar 19. North Delhi Areas 20. Okhla Areas Sahara Manovikas Pitampura Kendra A Project of Janseva Education Society Child Guidance Jamia Millia Centre 21. Okhla Areas Child Centre 22. Okhla Areas Society for Friends Jamia Millia Ship, Education and Development (Sofed) 23. Okhla Areas 24. Okhla Areas Deaf and Dumb Bharat Nagar Cooperative Industrial Society LTD. Delhi Cheshire Okhla Marg home 25. Okhla Areas 26. Okhla Areas Guidance Jamia Millia Disabled persons Custodial Care of Destitute Mentally ill mentally ill 6 to 16 years male and 6 to 18 years female Special Education, Visually Vocational Training and impaired hostel facilities placement and rural rehabilitation Primary day school for the Orthopaedically disabled in the age group of handicapped 3 to 15 years CO- educational day school Mentally ill for mentally disabled speech therapy, psychological guidance etc. Centre for hearing impaired Multiple physically impaired, Disabilities in facilities like education, the age group of Jobs, Marriages 3 to 40 years Hearing impaired, Etc. mentally ill. Co- educational primary day Multiple school for the mentally disability disabled and children with speech problems in the age groups of 4 to 15 years Special Training, Speech Mentally ill, Therapy, occupational speech disorder, therapy etc. Hearing impaired Centre for children above 2 Mentally ill years with psychological, Educational, behavioral and speech problems Diagnostic and therapeutic Multiple services, Remedial teaching Disability programme Day care center for aged, Multiple Health services reading Disability room and library Counseling and guidance for community services Employment for hearing Hearing impaired, weaving and impaired handloom, stitching etc. Physiotherapy, Vocational Orthopaedically Training. Residential center Handicapped for orthopaedically and mentally handicapped Day boarding School and Mentally ill rehabilitation center Delhi Society for Okhla Marg the welfare of mentally retarded children Hemophilia Society New Friends Locates and Helps people Hemophilia ( Delhi ) Colony with bleeding disorder 27. 28. 29. 30 31 32 33 34 35 36 37 38 39 40 41 42 treatment guidance and counseling Okhla Munishri Roop Sarai Kale Khan Naturopathy, yoga and Special Areas Chandra Bus terminus acupuncture center. Treatment for Naturopathy and Conducts awareness and specific disorder Acupuncture promotes camps Okhla YMCA Institute for Nigamuddin Day care center, Special Mentally Areas special education School for professional retarded courses Okhla Vimhans (Vidhya Nehru Naga Medical and social Orthopaedically Areas Sagar institute of rehabilitation provided Handicapped, mental health and through neuro rehabilitation Cerebral palsy Neuro sciences clinic, child guidance center and neuro physiotherapy, Occupational logical therapy, Speech therapy etc. Old Delhi ADP- North Delhi- Mukherjee Nagar Awareness campaign, Orthopaedically Areas A project of world check-up camps for Handicapped. Vision India disabled persons Old Delhi Child Guidance Delhi University IQ Test, Speech therapy Multiple Areas Centre Combinative work, play disability therapy and diagnosis Old Delhi Govt. Secondary Kinsway Camp Residential secondary Visually Areas School for Blind school for visually impaired impaired Boys boys in the age group of 5 to 20 years Co- educational primary Hearing Old Delhi Nursery Primary Kinsway Camp Areas School for the school for hearing impaired impaired Deaf in the age group of 4 to 15 years Old Delhi Parmath Mission Shakti Nagar Physiotherapy, laboratory Orthopaedically Areas Hospital (X-ray) ultrasound test Handicapped Old Delhi Society for child Shakti Nagar Data is not Data is not available Areas Development available Old Delhi Raghudev Rajpur Road Co- educational vocational Mentally Areas Memorial School of training center for mentally retarded Vocational Studies retarded upto the age of 16 years Old Delhi Saini Speech and Darya Ganj Speech therapy language Mentally Areas Hearing Clinic articulation, Audiometric retarded and fitting of hearing aids. South Aashray Adhikar G.K. Part II Study and Assessment, Children, Delhi Abhiyan Sensitization, Shelters for Women, elderly, Areas homeless and Information disabled. dissemination and documentation Special Education, Physio- Multiple South Astha (Alternative G.K. Part II Delhi strategies for the therapy, Speech Therapy Disability Areas handicapped and counseling, South Balvantray Mehta G.K. Part II Academics and social Mentally ill Delhi Vidya Bhawanintegration of mentally subAreas Anguridevi Sher normal, Vocational training Singh Memorial and job placement etc. Academy Action For Autism Chirag Gaon South Training in basic living Autism and Delhi skills, special education etc. learning Areas disabilities Akshay Vasant Kunj South Coeducational primary day Orthopaedically Pratrishthan Delhi school, art, craft and music disabled Areas and Vocational Training etc. 43 South Delhi Areas Concerned Now 44 South Delhi Areas South Delhi Areas South Delhi Areas Nav Jyoti Centre 47 South Delhi Areas Multipurpose Jit Singh Marg Training Centre for the Deaf 48 South Delhi Areas Sanjivini Society Jit Singh Marg for Mental health 49 South Delhi Areas 50 South Delhi Areas 51 South Delhi Areas South Delhi Areas Asso. For Vasant Enclave Advancement a rehabilitation of handicapped (AAROH) Carenidhi (Centre AIIMS for Applied Research and Education on Neuro Development impairment and Disability health initiatives Child guidance AIIMS Clinic 45 46 52 Action Vasant Kunj Vasant Kunj All India Fed. Of Jit Singh Marg the Deaf- Training Centre Federation for the Jit Singh Marg welfare of Mentally Retarded Genetic and AIIMS Mental Retardation Clinic 53 South Delhi Areas Rehabilitation unit AIIMS in Audio logy of speech pathology 54 South Delhi Areas Child center 55 South Delhi Areas Muskaan Parents Hauz Khas association for the welfare of children with mentally handicapped guidance Hauz Khas Advocacy for rights of All Disabilities disabled people, participatory research using action learning technique and collection and dissemination of information Coeducational day school Mentally ill for mentally ill in the age group of 6- 32 years Hostel, Multipurpose Hearing training for the deaf impaired Special education, Medical Mentally and other supportive Retarded therapy and vocational training Coeducational residential Hearing vocational training center impaired for the hearing impaired in the age group 16-30 years Free and confidential Emotional counseling on telephone Problem, Behavioral and in person Disorder. Social awareness, Mentally ill Programme and occupational center for mentally ill Seminars, Multiple Workshop, Survey and publications disability Assessment, treatment and Mentally ill, Slow parent training and learners counseling Outpatients clinic for Multiple genetic and birth defect, Disability, surveys and counseling Genetic and birth defect Rehabilitation unit were all Mentally ill types of cases with speech, language and voice disorders are diagnosed. Diagnostic and counseling Multiple center, Guidance, disability slow Assessment, Speech learners in the therapy etc. age groups 0-14 years. Vocational Rehabilitation, Mentally Parent training and Handicapped counseling 56 South Delhi Areas 57 South Delhi Areas NCPEDP (National Hauz Khas Centre for promotion of Employment for Disabled Persons Spastic Society of Hauz Khas Northern India (SSNI) 58 South Delhi Areas The Education Hauz Khas Charitable Trust (Regd.) 59 South Delhi Areas South Delhi Areas South Delhi Areas South Delhi Areas Hemophilia Mohammad Federation ( India Village ) Jan Madhyam Zamrudpur 60 61 62 63 64 65 66 67 68 69 70 71 72 73 South Delhi Areas South Delhi Areas South Delhi Areas South Delhi Areas South Delhi Areas South Delhi Areas South Delhi Areas South Delhi Areas South Delhi Areas South Delhi Areas South Delhi Janta Adarsh Andh Sadiq Nagar Vidyalaya Sahas Society for Sadiq Nagar the Welfare of Mentally handicapped Delhi Sports Saket Council for the Deaf Samadhan Samadhan Sankaras Kendra Tamana Association Vidya Vasant Vihar Vasant Vihar Helping to find employment Multiple opportunities for disabled disability person, conducting workshop and seminars Technical rehabilitation Cerebral palsy, inputs, assessment, Neuro muscular vocational training in rural disorder and urban areas Diagnostic, Remedial Dyslexia, teaching, Coeducational day Attention deficit school for children with disorder learning disabilities Pur Locate undiagnosed person Hemophilia with hemophilia Home Based intervention, Multiple Vocational Training and Disability social training etc. Primary residential school Visually for visually impaired in the impaired age group 8-18 years Vocational Training, Special Mentally ill Education for mentally ill Providing recreational Hearing services through game and impaired sports Educational and Vocational Mentally training. Retarded Vocational looms Training on Mentally Retarded Special education, training, Mentally rehabilitation counseling Handicapped and training Vidya Bharati Vasant Vihar Co- educational primary day Mentally ill Fondation school for the mentally ill in the age group 6-21 years SAPNA Asiad Village Co-educational Orthopaedically rehabilitation for disabled in Handicapped the age group 14-18 Years Special Centre Govind Puri Ext. Co-educational day center Mentally ill for the mentally ill in the age group 6-14 years Thalassemics India Safdarjung Dev. Blood donation camps, Thalassemia Area Thalassemia screening camps, Talks, Seminars etc. The National R.K. Puram Preparatory School, Visually Association for the Integrated education, impaired Blind employment and placement services Udaan for the Kailash Colony Physiotherapy, Speech Mentally ill Disabled therapy and Need based education. Bharat Blind Madangir Residential primary school Visually Technical Welfare for the blind, Vocational Impaired 75 Central Delhi 76 Central Delhi Society Aliyavar National Lajpat Nagar Institute for the Hearing handicapped ADP- South Delhi Lajpat Nagar IA Project of World Vision) World Vision India Lajpat Nagar (refer Sl. 7 of II) 77 Central Delhi Child center 78 Central Delhi Institution for the Lajpat Nagar Blind 79 Central Delhi 80 Central Delhi Model School for Lajpat Nagar Mentally Deficient children National Institute Lajpat Nagar for mentally Handicapped 81 Central Delhi 82 Central Delhi 83 Central Delhi 84 Central Delhi 85 Central Delhi All India Sports Puchkuina Road Council of the Deaf 86 Central Delhi Andh Vidyalaya 87 Central Delhi Central Delhi Hind Kusht Puchkuina Road Nivaran Sangh Institution for the Puchkuina Road Blind (Andh Vidyalaya) Ashray (Asso. For Kamla Market Social Health of Rehabilitation Action by youth Delhi Asso. Of the Kamla Market Deaf Asso. For the Defence Colony Development of 74 88 Areas Central Delhi 89 Central Delhi 90 Central Delhi Central Delhi 91 guidance Lajpat Nagar National Institute Lajpat Nagar for mentally Handicapped Rashtriya Lajpat Nagar Virjanand Andh Kanya Vidyalaya Society Society for Lajpat Nagar Rehabilitation of Research of the handicapped All India Puchkuina Road Federation of the Deaf Maha Puchkuina Road training Co-educational therapeutic Hearing institution, OPD Setup for Impaired the hearing and speech impaired. Income Generation, Skill Orthopaedically Development, Vocational Handicapped Studies etc. ADP (Area Development Overall Programme) North and Community Development South Centre for children in the Mental Disability age group of 0-16 years with psychological and communication problems Primary residential school Visually for visually impaired boys Impaired Boys and Vocational Training School, Hostel, Vocational Mentally Training and Clinical Retarded services etc. Therapeutic center for the Mentally ill mentally and physically disabled in the age group 06 years Early intervention, Mentally Assessment and evaluation Handicapped clinic and Vocational Centre Residential Vocational Visually Training Centre for visually Impaired Girls impaired girls Co-educational day school Hearing for the hearing impaired in impaired the age group 0-10 years Co-educational school, Hearing training production center impaired for hearing impaired in the age group 16-30 years Promotion of sports and Hearing games among the deaf in Impaired the country Middle school for visually Visually impaired boys in the age impaired group 7-18 years Leprosy Control Leprosy cured Primary Residential School Visually Impaired Boys Remedial Education center Multiple Disability Training in Type Writing Hearing Impaired Multiple Disability Nursery school 92 Central Delhi 93 Central Delhi 94 Central Delhi Central Delhi 95 Central Delhi 96 Central Delhi Central Delhi Central Delhi Central Delhi Central Delhi 97 98 99 100 101 102 103 104 105 106 107 108 109 Central Delhi Central Delhi Central Delhi Central Delhi Central Delhi Central Delhi Central Delhi Central Delhi Central Delhi 110 Central Delhi 111 Central Delhi 112 Central Delhi Multiple handicapped children Very special Arts Karol Bagh India Asso. Of the Paharganj National brotherhood for social welfare Delhi Foundation Paharganj of Deaf women Paharganj National Federation of the BLIND Connaught Bhagwan Mahaveer Vikas Sahayta Samiti Bharatiya Vidya Connaught Bhawan Dept. of Social Connaught Welfare Handicapped Connaught welfare Federation India Vision Connaught Foundation New Delhi Young Connaught Men's ChristianAsson Pawan Connaught Remedial Therapy and Multiple visual arts And Vocational Disability Training Awareness Education Orthopaidically Handicapped and Mentally ill Training for hearing Hearing Impaired women Impaired Vocational Training Hearing impaired women 18 years above Place Placement service for blind Visually Impaired Place Artificial Limbs Physically Handicapped Place Education for Slow Learner Slow Learners and Counseling Place Place Place Place Rajeev Gandhi Connaught Place Foundation St. Thomas Connaught Place GirlsSenior Secondary The Enabling Connaught Place Centre Child Guidance Connaught Place Clinic Aanchal School Kantiya Marg Blind Relief Asso. Oberoi Hotel Dept. of Psychiatry Ram Manohar Lohiya Hospital Govt. Lady Noyce I.T.O Secondary School for the Deaf I.T.O Occupational therapy home for children School for I.T.O mentally retarded children The Institute for I.T.O the physically handicapped (Ministry of Social 113 114 115 116 117 118 119 120 121 122 123 124 125 126 127 128 129 130 131 132 Central Delhi Central Delhi Central Delhi JUSTIC OF empowerment, govt. of India The Leprosy I.T.O Mission ( India ) Hope Foundation Jung Pura Jeevan Jyoti Missionaries of Charity Vikas Kunj Central Indcare Delhi (Integrated Nat. Dev. Centre for Advancement, Reform of Education Central Rashtriya New Rajendra Delhi Virjanand Andh Nagar Kanya Vidyalaya Society East Delhi All India Deaf and Preet Vihar Areas Dumb Society Karkardooma East Delhi Amarjyoti Areas Research of Rehabilittion Centre East Delhi Bharat Blind Shahadara Areas School East Delhi Bharatiya Blind Shahadara Areas Educational Cultural Welfare East Delhi Prakash Deep Shahadara Areas Educational of Vocational Society East Delhi Pramila Bai Shahadara Areas Chauhan Mook Badhir Vidyalaya East Delhi Suniye Shahadara Areas East Delhi Delhi Bharat Vikas Dilshad Garden Areas Foundation East Delhi Mahalakshmi Mayur Vihar Areas Udyug Shala East Delhi National Blind Patpatganj Depot Areas Youth Asso East Delhi Well Being Sakarpur Areas Counselling of Halth Centre East Delhi Cripple Aid Trust Jhilmil Areas Misc. Delhi Brotherhood Court Lane Address Society Misc. Govt. Model Senior Shyam Nath Address Secondary School- Marg 2 Misc. Maximising Udai Park Address Employment to Serve the Handicapped 133 134 135 136 Misc. Address Misc. Address Misc. Address Misc. Address (MESH) Navkiran School Kiran Vihar ( K.D. Hospital ) OUBURE (Org, for Shastri Nagar ( Ubiquitous Back- Ghaziabad ) Ward Uplifting Research and Education ParivarA Nataji Nagar Federation Raj Kumari Amrit Lady Irwin Kaur Child Study College Centre Activity and major focus area of some of the NGO's not reported in the above table is being collected and the same will be presented in the final report. Annexure-2 Delhi Metropolitan Region NGOs/ Organizations working for Disabled Persons Selected for Survey SL. NO NAME OF THE ORGANISATION 93. Nirmal Joyti ADDRESS Vasant Vihar DISABILITY Type Physically , Deaf and Dumb Disability Kalkaji Mentally Retarded Slow Learner 94. ORKIDS The learning Centre 95. Bharatiya Blind Education culture welfare Shahdara society Blind 96. All India Deaf and Dumb Deaf 97. Association of National Brotherhood for Janakpuri social welfare Mental, Disability 98. Amarjyoti Centre Mental Disability Slow Learner 99. Janta Adarsh Andh Vidyalaya Sadia Nagar 100. Blind Relief Asson Lal Bahadur Shastri Blind Marg. 101. Prabha Institute of Fine arts and crafts for Paharganj disabled person Mental, Disability 102. All India Fedration for the deaf R.K. Ashram Marg Deaf and Dumb 103. National Fedration of the Blind Paharganj Blind 104. Concerned Action Now Vasant Kunj Mental, Physical, Deaf and Dumb Disability 105. Zakir Hussain Memorial child guidance Jamia Nagar center Rehabilitation Karkari Morh and Research Karkardooma and Physical and Blind Mental, Disability Physical Physical 106. Maximising Handiapped 107. eployment to sere the Uday Park Mental, Physical, Deaf and Dumb Disability Deepaahram Rajiv (Gurgoan) Nagar Mental, Physical, Deaf and Dumb Disability 108. Naturopathy and Aupunture Sarai Kale Khan 109. Masoom Barakhamba (CP.) 110. Institution for the Blind Punhkuin Road Blind 111. Delhi Association of the Deaf Kamla Market Deaf 112. Sanjivini Society for mental health Satsang Vihar Mentally Retarded 113. National Association for the Blind RK. Puram Blind and Handicapped 114. Andh Maha Vidyalaya Pachkuin Road Blind 115. Akhil Bharatiya Netraheen Sangh Rajhubir Nagar Blind 116. All India onfedration of the Blind Rohini Sector 5 Blind 117. Tamana Special School Vasant Vihar Mental Disability 118. Federation for the Welfare of the mentally Shahid Jeet Singh Mental Disability Retarded Marg 119. Balwanti Rai Mehta Vidya Bhawan 120. Physically Disabled and Paralysis Road Mental Disability G.K. II Mentally Retarded Hearing Disability and Delhi Society for the welfare of Mentally Okhla retarded children Mental Disability Physical Disability and 121. Rastriya Rirzananad andh kanya Vidyalaya Manohar Nagar Society Blind 122. The Educare center Hauz Khas Learning Disability 123. Delhi Council for child welfare Civil lines Physical Disability 124. Saini Speech and Hearing clinic Dariya Ganj Deaf 125. Tamana Association Vasant Vihar Mental Disability Physical Disability 126. Muskaan Vasant Kunj Mental Disability 127. Deepalayas Janakpuri Mental Disability Physically Disability 128. Danish Assistance of National Programme Safdarjung Enclave Blind for control of Blindness 129. Venu Charitable society Sheik Sarai Blind 130. Church's Auxillary for social action Rajendra Place Physically Disability and Handicapped and and 131. National association for the blind R.K. Puram Blind 132. Akshay Pratisthan Vasant Kunj Orthopedic Mostly 133. Inspiration Vikas Puri 134. Action for Autism Defence colony Mental Disability/Spastic/Autistic and Multiple Handicapped Multiple Disability Aradhana Parents support group Preet vihar Mental Disability 139. Family of Disabled Janakpuri 140. Action aid India Greater Kailash Mental Disability , Physically Disability blind Deaf and Dumb Physically Disability 141. Universities Grants commission Govt. of Bahadur Shah Zafar Mental Disability India Marg Physically Disability 142. Chetanalaya 143. Care Nidhi 144. National Centre for Promotion Employment for Disabled People 145. Suniye Shahadara Deaf 146. Department of Family Welfare Nirman Bhawan 147. Association for Development of Human Gandhi Nagar Action and Rehabilitation Mental Disability , Physically Disability blind Deaf and Dumb Physically Disability 148. Area Development Programe 149. Child Guidance Clinic 150. The Institute handicapped 135. 136. 137. 138. 151. 152. , Bhai Vir Singh Marg Mental Disability , Physically Disability blind Deaf and Dumb Ansari Nagar Mental Disability for the of South Extension South Delhi Multiple Disability Multiple Disability Bangla Sahib Marg Mental Disability, Physically Disability, Deaf and Dumb and Blind Also physically Vishnu Digambar Physical Disability Marg 153. Delhi Society for the welfare of mentally Okhla Marg retarded children Mentally Disability 154. National Thalassemia welfare society Patient Care 155. Sadhu Vaswani International school for Shantiniketan girls Mentally Disability 156. Action for Autism Chirag Gaon 157. Institute for blind andh vidyalaya Lajpat Nagar Mental Disability, Hearing Disability, Down's Syndrome and Autism Blind 158. Sanam manovikas Kendra Pitampura 159. National Institute for mentally handicapped Lajpat Nagar Mentally Retarded 160. Bharat Blind technical welfare society Central market Physical Blind 161. Delhi Cheshire home Okhla Multiple Disability 162. Bharat Blind school Shahdara Blind 163. The Enabling center Sikandara Road 164. Awaaz Special school Kirti nagar 165. Vikalang Sahara Samiti Mangolpuri Mentally Retardation , Cerebeal Palsy, Physical Disability and Autism Mental Disability, Physical Disability, Deaf and Dumb Ortapaedically Disability 166. Vidya Integrated Development for youth Hauz Khas and adults Mental and Disability Physical 167. Mata Bhagwanti chadha Niketan Mental and Disability Physical 168. Deaf and society 169. National Blind youth association Patparganj Extension) 170. National Association for the blind R.K. Puram Blind, Deaf Blind, Multi handicapped Disability 171. The spastic society of northern India Hauz Khas Physically Disability 172. Samadhan Dakshin puri 173. Special Education unit K.G. Marg Mentally Handicapped, mentally handicapped with visually impaired, Cerebral Palsy and Autism Mental Disability 174. Very special arts India Vasant Kunj Dumb cooperative Vikas puri Mentally Disability Physically Disability Vasundhara Enclave (Nodia) industrial Bahart Nagar Disability and and Deaf and Dumb (I.P. Blind Mental Disability, Physical Disability Blind, deaf and dumb 175. Doon Research and Rehabilitation Ramesh Nagar Mental Disability, Autism, Speech and Hearing, Multiple Disability Annexure- 3 Research Project on Atlas of Services for Disabled Population in Delhi (NCR) 1. Name of organization with address. • Organisation Status NGO/Private/ Other Specify • Year of establishment 2. Name, Address and designation of the contact person 3. State major mission/ objective of the Organisation 4. Target group Children/ Males/ Females/ Other Specify 5. Details of the disability groups undertaken for services rehabilitation. Mental Disability/ Physical disability blind/ deaf/ dumb. • Detailed activities undertaken for the target group. Activity 1. Education Details of Services Provided 2. Health 3. Counselling 4. Vocational Training 5. Other Specify 7. Give profile and outcome of your work activities year wise. • How do you identify the target groups for services/ rehabilitations? • Area and social groups covered for the activities undertaken by the Organisation Areas/ Colonies in Delhi States Covered • Infrastructure in the Organisation Infrastructure 1. Building Details 2. Hospitals 3. School 4. Vocational Training Course 5. Equipment 6. Others 11. Infrastructure and services existing and Requirements. Infrastructure Requirements Existing 1. Building 2. Equipments 3. Manpower 12. Source of Funding 13. State major services required for the Target groups covered by your organization. 14. What is the present scenario of services for the target in Delhi especially for Education, Medical- Care, and transportation and for other day-to-day activities? 15. Manpower of the Organisation Name of the Staff Academic qualification Technical Qualification 16. Support given for job Facilities to the Disabled Population. 17. State number of person supported for the Job 18. Name organization/ Factory where they are working? 19 Comment and Observation Annexure- 4 Questionnaire for Disabled Respondent 1. Organization Job Activity 2. Name, Age, Sex and Address of the Respondent 3. Nature of Disability 4. How did you get in touch with this organization 5. Year and date of association with the Organization • Were you getting any service from any other Organization (Yes/ No) • If Yes state name and activities of that Organization and period. 6. State Service provided by this Organization for disabled population. • How has the students provided by this Organization helped you? • Are you satisfied with this service provided by this organization (Yes/ No) If No state major reasons? 9. Give details of service required by you to meet your day-to-day requirements keeping in view of your disability. 10. What is the present position of availability of these service in your locality/ Delhi . Locality Delhi 11. Recommendation to improve the services for disabled in Delhi . Education Transport Medical Service Any Other Annexure- 5 Delhi Metropolitan Region List of Surveyed Physically and Mentally Impaired Persons S. No Name of the organisation Name of the Male person /Female 176.Delhi Association of the Deaf Gagan Singh Male Age Type of Disability 20 Deaf 177.National Association for the Archana blind Female 8 Blindness 178.Akshay Pratisthan Anjum Female 14 Lower Lips 179.Institute for the Blind Prakash Mahto 20 Blind 180.Andh Maha Vidhalaya Vijay Gupta Male 20 Blind Netraheen Arun Kumar Male 21 Blind 182.All India Confederation of the Aamir blind Male 25 Totally Blind 183.Tamana special school Male 15 Paralysis in hands and legs 17 Blind 181.Akhil Bharatiya Sangh 184.Rastriya Birjanand Kanya Vidyalaya Kumar Male Joginder Andh Pooja Srivastava Female 185.Association for national Sumit brotherhood for social welfare Awarthi Kumar Male Mental Retarded 186.Amarjyoti Rehabilitation and Mamta Research center Female 23 Orthopadically Disabled 187.All India Society Dumb Dushant Male 15 Deaf 188.Bharatiya Blind Education Dinesh culture welfare society Sharma kumar Male 26 Totally Blind Deaf and 189.All India federation of the Sudeep Ghosh deaf, Multipurpose Training Centre for the Deaf 190.Janata Adrash Andh Vidlaya Ashok Kumar Male 23 Deaf Male 21 Totally Visionless 191.Prabha Institute of Fine arts Jitender and crafts for the disabled person 192.The Enabling Centre K. Sudha Male 12 Polio Female 30 Paralysis in Lower limbs spastic 193.Very Special art India Male 18 Low Vision Epilepsy 194.Sadhu vaswani International Neha Bhutani School for girl Female 16 Speech/Slow learner/ Orthopedic 195.Sadhu vaswani International Smita Awasti School for girl Female 16 Cardiac Problem 196.Samadhan Chandan Male 25 Slow learner 197.Samadhan Suresh Male 12 198.Institution for the blind Ajit Kumar Male 16 Mentally Retarded, Speech problem and slow learner Partially/Blind Ajay Joshi 199.Institution for the blind (Andh Umesh Kumar Vidyalaya) Male 10 Blind 200.Sahara Manorikas Kendra Female 14 Mentally Retarded 201.Muskan Parents Association Karan Tandon Male for the Welfare of Children with Mentally Handicapped 202.Muskan Parents Association Sachine Sharma Male for the Welfare of Children with Mentally Handicapped 203.Bharat Blind Technical Vimal Kishore Male Welfare Society Awasthi 45 Mentally Retarded 20 17 Behavioral Problem, Mentally Retarded Blind 204.Bharat Blind Welfare Society Bir Male 23 Blind Bhawna Jindal Technical Chandra Singh 205.Bharat Blind School Arun Kumar Male 22 Blind 206.Bharat Blind School Dadhival Prakash Male 26 Blind 207.Development of Family Sameer Shetty Welfare Nirman Bhawan Male 14 Handicap 208.Development of Family Himanshu Welfare Nirman Bhawan Rajput Male 14 Handicap 209.Association for Development Satyam Singh of Human Action and Rehabilitation (ADHAAR) 210.Suniye Amol Kathani Male 18 Handicap Male 13 Deaf 211.Suniye Male 14 Deaf 212.National Centre for Promotion Hrishitta Bhatt of Employment for Disabled People (NCPEDP) 213.National Centre for Promotion Roopa Vohar of Employment for Disabled People (NCPEDP) 214.Care Nidhi Roswitha Joshi Male 20 Handicap Female 19 Handicap Female 18 Mental Disorder 215.Care Nidhi Aauradha Sharma Female 20 Mental Disorder 216.Chetanalaya Akash Deshpande Male 18 Handicap 217.Universal Grants Commission Chandra Prakash Male Government of India 18 Mentally Handicapped 218.Action Aid India Female 16 Handicap Female 20 Handicap Male 19 Blind Male 20 Handicap Emimanuel Amita Das 219.The Institute for the Archita Awastic Physically Handicapped, Govt. of India 220.All India Confederation for Ashutosh the Blind Agarwal 221.The Institute for the B. M. Sagar Physically Handicapped, Govt. of India 222.Maximizing Employment to Shubham Serve the Handicapped Sharma (MESH) 223.Akshay Pratishthan Center Rana Female 18 Leprosy Male 15 Handicap 224.Akshay Pratishthan Center Mukul Goyal Male 15 Handicap 225.Action for Autism Somnath Das Male 14 Autism 226.Action for Autism Mrinal Agarwal Female 14 Handicap 227.The Educare Centre Nilima Jain Female 10 Speaking Problem 228.The Educare Centre Ramesh Jain Male 12 Speaking Problem 229.National Association for the Gopal Saini Blind Male 20 Eye Problem 230.National Association for the Anuradha Blind Sharma Female 19 Eye Problem 231.Muskaan Karan Tandon Male 30 232.Muskaan Princey Male 24 Speaking Problem & Mental Retardation Mentally Retarded 233.Tamana Association Rajeev Singh Male 15 Mentally Handicapped 234.Tamana Association Sonali Jatav Female 16 Mentally Handicapped 235.Saini Speech Clinic and Hearing Sandeep Singh Male 18 Hearing Problem 236.Saini Speech Clinic and Hearing Namrata Jain Female 19 Hearing Problem 237.Delhi Council Welfare for Child Himani Female 14 Physical (Leg) 238.Delhi Council Welfare for Child Binod Sharma Male 10 Physical Problem Particularly (Leg) Problem Annexure- 6 Summary Report on Seminar/ Workshop conducted in Delhi . A one-day seminar on Services for Differently Abled Population In India was organized by the project AEII on 10th May 2003 at the India International Centre, New Delhi . Objectives: Objective of this seminar was to have a dialogue with government/ NGOs/ Civil society organization for effective implementation of the Disability ACT 1995 and its Rules 1996. The purpose is to seek information on services/ facilities and amenities required to provide equal opportunity without any discrimination to the disabled. The aim was to sensitize society and create awareness towards the responsibilities and duties for protecting human rights for the disabled population for their gainful employment and integration with the society. The Seminar seeks to: • Examine the magnitude and extent of different category of disabled population in India with special reference to National Capital Territory (NCT) of Delhi . • Evaluate demographic and social and economic profile of various categories of disabled population. • Identify the present service available for the different types of disabled populations in terms of institutions, community services, self-help groups etc in Delhi . • Evaluate the quality of infrastructure, manpower resource for guidance and training and technical support, infrastructure, counselling and equipments available in the centers for disseminating the identified services to the affected population. • Find out the gaps in the requirements and availability of services for the disabled population in the rehabilitation and other support centers. • Assess the impact of supportive services for creating suitable environment for better quality of life and opportunities for the disabled persons in social and economic sphere. • Prepare a set of recommendations for opening of services for the displaced population keeping in view the requirements of the area and to suggest improvements for present services in terms of staff training, curriculum development and purchase of equipments and other supportive programmes. Participation: Justice Rajinder Sachhar (Ex-Chief Justice of Delhi High Court) chaired the Seminar and Mr. Javed Abidi, Director, National Centre for Promotion of Employment for Disabled People (NCPEDP) delivered the Theme Address. Other participants in the seminar were academician and research students from Delhi University, Jawaharlal Nehru University and Jamia Milia Islamia, Government officials from Institute for Physically Handicapped and Vocational Rehabilitation Centre for Disabilities, representatives from Civil Society Organizations like National Association for the Blind (New Delhi), Amar Jyoti, Hemophilia Federation, Initiative for Social Change and Action, Himalayan Research and Cultural Foundation, Developmental Integrated and Value Applications, Institute of Public Opinion, Institute of Research and Action Planning, Awaaz Special School, DLDAV, Association of Kashmiri Samiti, Indian Social Institute, Manzil Welfare Society, SAI Pragya Institute, ADDI ( Spastic Society of India), Delhi Brotherhood Society, Sadhu Vaswani School, Family of Disabled, SPANDAN, Blue Bell School, Delhi Association of Deaf, TWMR Special Institute, DOON Research and Rehabilitation Centre for Handicapped, Child Guidance Centre, ADHAAR, VIDYA, Spastic Society (Delhi) and Mass media, All India Radio and other print media. Major Focus of Discussion: • Establishes responsibility on the society to make adjustments for disabled people so that they overcome various practical, psychological and social hurdles created by their disability. • Provisions to ensure equal opportunities without discrimination to all disabled people in Employment and protection of rights and full participation of disabled people in mainstream activities of the society. • Responsibility to prevent disabilities, provision of medical care, education, training, employment and rehabilitation of persons with disabilities. • Creating barrier-free environment for them, remove any discrimination against them which prevents them from sharing the development benefits, counteract any abuse or exploitation, lay down strategies for comprehensive development of programmes and services and for equalisation of opportunities. Recommendation of the seminar: • Government of India must undertake revision for identification of job list for disabled population for 3% reservation in government and PSUs, keeping in view the spirit of elimination of negative jobs for disabled rather than identifying positive jobs for disabled. The Committee for job identification list should include people from all walks of life including the disabled and pragmatic approach must be adopted for identifying job list. • More categories of disability must be included in the Act for provision of reservation benefits especially mentally disabled, autism, hemophilia and Alzneimer's disease etc. • Disability should be taught as a separate discipline in the colleges and Universities with an integrated multi-disciplinary approach. • Regular promotions without positive discrimination to disabled staff in government and PSUs to next grade should be given in time. • Immediate adoption of Incentive policy for providing incentives to private sector for promoting employment of disabled. Employment of disabled should be made mandatory for the organizations supported by government funding. • Easy access of loan at lowest interest rates for disabled especially for women for encouraging self-employment entrepreneurship. Their self-employments schemes must be monitored and sheltered with support from government and civil society agencies. • Private sector should be encouraged and sensitised to provide equal opportunities without positive discrimination to disabled population through persuasion, awareness and pressure lobby. • Government of India should accord priority to poor persons with disabilities in all poverty alleviation programmes. • Priority must be given to disabled women in all policies and programmes aimed at eradicating discrimination against them and providing necessary training skills for their income generation support. • Residential care for those disabled that is without any support from families must be given top priority. • The Disability Act 1995 and its Rules 1996 must be translated into all regional languages, so that its various provisions, benefits, etc. become widely known. • Coverage in programmes must be increased in the electronic and print media, which promote positive attitude towards persons with disability. • Appropriate financial, technical, human resource and infrastructure support should be made available through centre and state funds for education, technical and professional training for children and adults with disabilities throughout the length and breadth of the country. Identification of such target groups should be conducted at micro levels through field surveys. • Counsellors who can provide S.I therapy should be appointed in all schools (government and private) to identify learning disabilities among the school-going children. Curriculum for mentally disabled or learners with disability must be made appropriate and tailor-made to reduce their stress. • Early intervention for minor impairments should be made mandatory through hospital services for prevention of these impairments turning into chronic impairment cases later. • Collective efforts must be made by the entire society to integrate disabled with society for social contacts and participation in leisure and recreational activities.