People with Disabilities in

India: From Commitments to

Outcomes

“The problem is not how to wipe out the

differences but how to unite with the differences
intact”. – Rabindranath Tagore

Philip O’Keefe
Lead Social Protection Specialist
World Bank, November 2007
The disability study – Background and sources

Main sources –
- Analysis of NSS disability rounds and
census
- Administrative data
- Commissioned survey of villages in UP and
TN in 2005 (with DFID TF financing)
- Series of background papers
- Reviews of secondary literature
- Field visits to 6 states during preparation
- Lots of inputs and support from NGO/DPO
community
 Disability study – main sections

‹ Definitions
‹ Socio-economic profile
‹ Attitudes to disability and disabled people
‹ Education
‹ Employment
‹ Health
‹ Social security
‹ Institutions and policies
‹ Accessibility
 Key messages of the report

‹ The number of people with disabilities in India is

substantial and likely to grow - disability does not
“go away” as countries get richer

‹ People with disabilities in India are subject to

deprivation in many dimensions of their lives.

‹ Social attitudes and stigma play an important role in

limiting the opportunities of disabled people for full
participation in social and economic life, often even
within their own families.

‹ India has one of the more progressive disability

policy frameworks in the developing world. However,
there remain huge challenges in operationalizing the
policy framework
 Key messages of the report

‹ Increasing the status and social and economic

participation of people with disabilities would have
positive effects on everyone, not just disabled
people.

‹ India has a vibrant and growing disability rights

movement and NGO/DPO and civil society
involvement in service delivery for people with
disabilities.

‹ While there is a long way to go, focusing on “getting

the basics right” on disability policy would allow for
significant progress in the foreseeable future.
The number of people with disabilities in
India is substantial and likely to grow
‹ Official disability rates remarkably low – as in most of
SAR –– 2.13 % of individuals in census and 1.8 % NSS
‹ BUT – even with this, NSS says 8.4 % of rural HH and 6.1
% of urban have a disabled member
‹ Major divergence on composition of disability
between official sources
Disability shares by type, census and NSS, early 2000s

Multiple

Locomotor
Dpopulation

Speech
Census rates
NSS rates
%of PW

Hearing

Visual

Mental

0 10 20 30 40 50 60
The number of people with disabilities in
India is substantial and likely to grow
The report estimates a wide range of 4-8
percent of the population with a disability

Why the difference ?

‹ Measurement methods used in official

surveys/census
‹ Based on previous reliable surveys of specific
disabilities
‹ Social attitudes and stigma
‹ International evidence
‹ Much of the “gap” is driven by mental retardation
and mental health measurement
The Disability Profile is Changing

Share of Disability Adjusted Life Years by

Cause
70
60
50
40 1990
%

30
20 2020
10
0
un
un

ry
ju
m
m

In
om
m
Co

C
n-
No
Disability does not go away as countries
get richer

10.00

8.00

6.00

4.00

2.00

0.00
AFR SA EAP MNA ECA LAC OECD High
Income

Average disability rate pop. w eighted avg. disability rate

 Disabled People are a Heterogeneous Group

Hearing Speech
.02

.025
.015

.02
.015
Density

Density
.01

.01
.005

.005
0

0
0 20 40 60 80 100 0 20 40 60 80 100
Age at onset Age at onset

.025
.04

.02
.03

.015
Density
Density
.02

.01
.005
.01

0 20 40 60 80 100
0

Age at onset
0 20 40 60 80 100
Age at onset

Locomotor Mental
Disabled People are a Heterogeneous Group

.03
.02
Density
.01
0

0 20 40 60 80 100
Age at onset

Visual
Disabled People are a Heterogeneous Group

Extent of disability Share of all PWD

Can not for self even 13.6%

with aid

Can care for self only 17.2

with aid

Can care for self w/out 60.2

aid

Aid/appliance not 9.0

available
 People with Disabilities are Subject to
Multiple Deprivations
They are Poorer and have “conversion handicap”
‹ Households with PWD one quarter less likely to
report 3 meals a day year round
‹ They are more likely to be in low income groups
Figure 1.3

1.4

1.2
Incidence relative to average

0.8
PWD
PWD severe
0.6

0.4

0.2

0
Q1 Q2 Q3 Q4 Q5
 People with Disabilities are Subject to
Multiple Deprivations
They are much more likely to be illiterate and
out of school
Figure *.*: Share of 6-13 year olds out of school by social category, 2005

Multiple
Locomotor
Speech
Hearing
Visual
Mental
All disabled

Muslim
OBC
ST
SC
Females
Males
All children

0 10 20 30 40 50 60 70
% of category out of school
 % o f w o r k i n g a g e p o p u l a ti o n

0
10
20
30
40
50
60
70
80
90
100
RM PW D
RM GEN

UM PW D
UM GEN

RF PW D

Figure 5.2
RF GEN

UF PW D
UF GEN

A LL P W D
A LL G E N

% o f w o rk in g a g e p o p u la tio n

0
10
20
30
40
50
60
70
80
90
100

RM PW D

RM GEN

UM PW D

UM GEN

RF PW D
Figure 5.3

RF GEN
Multiple Deprivations

UF PW D
gap to the general population has grown

UF GEN

A LL P W D

A LL G E N
They have much lower employment rates and the
People with Disabilities are Subject to
 People with Disabilities are Subject to
Multiple Deprivations
They often have low awareness of rights and
entitlements
‹ 94% of HH with disabled member have not heard of PWD
Act in rural TN and UP
Figure *.*: Share of PWD HHs not aware of entitlements

Transport subsidy

Job reservation

Education stipend

Employ exchange
TN
Subsidy on credit
UP
Aids/appliances

Food ration

PWD benefit

PWD certificate

0 10 20 30 40 50 60 70 80 90 100
%
 People with Disabilities are Subject to
Multiple Deprivations
‹ They are subject to strong social stigma within
community and families which is often
internalized
Figure *.*: Belief that disability a curse of God, rural UP and
TN, 2005

TN non-PWD
UP non-PWD
All non-PWD

TN PWD
UP PWD
All PWD

0 10 20 30 40 50 60 70
% of respondents
 India has one of the more progressive
disability policy frameworks in the
developing world
‹ PWD Act, 1995

‹ National Policy on Persons with Disabilities, 2005

‹ Ratification of UN Convention on Rights of Persons with

Disabilities (Oct. 2007)

‹ State Policies starting (e.g. Chhattisgarh)

‹ Sector-specific policies emerging – e.g. National Action Plan

for Inclusion in Education of Children and Youth with
Disabilities – 2005/06
 But there remain huge challenges in
operationalizing the policy framework

‹ Inherent challenges of inter-sectoral coordination

‹ Awareness among service providers, officials and
PWD often low
‹ Executive Coordination Structures very weak in
most states
‹ Commissioners’ offices usually under-resourced
in funds and people
‹ Mechanisms for service outreach below district
level remain under-developed - unclear PRI
strategy
‹ NGO sector vibrant but challenges to expand into
rural areas and to strengthen business processes
 But there remain huge challenges in
operationalizing the policy framework

Figure *.*: Top difficulties in applying for PWD benefits and

services, UP and TN, 2005

No dif f iculties

Other

Other communication barriers

Poor communication of rules

Corruption

Lengthy/complex procedures

Non-cooperative of f icials

Lack of inf ormation

Lack of transport

Distance

Physical barriers

0 5 10 15 20 25 30 35
Share of PWD reporting as major difficulty
 Key recommendation of the
report: “Get the basics right”
What does that mean in practice ?

‹ Preventive care - both for mothers through nutritional

interventions, and infants through both nutrition and basic
immunization coverage. Improve road and workplace safety
‹ Identifying people with disabilities as soon as possible
after onset - the system needs major improvements in this
most basic function
‹ Major improvements in early intervention, which can cost
effectively transform the lives of disabled people, their families,
and the communities they live and work in
‹ Getting all children with special needs into school and
giving young disabled adults the skills to participate fully in
family and economic life
‹ Expanding efforts to improve societal attitudes to people
with disabilities, relying on public-private partnerships that
build on successful models already operating in India
 The Good News…
‹ A lot of these things are already
happening through many initiatives
‹ Good practice states like TN, AP and
Karnataka show that major improvements
can be made at scale
‹ The question is how to mobilize social
commitment and how to develop delivery
systems which can work at scale,
especially in rural areas