Rapid Assessment of Disability (RAD): An instrument to support disability inclusive development

1. Rapid Assessment of Disability (RAD):An instrument to support disability inclusive development Dr Nathan Grills (MPH, MBBS, DPHIL, DPH) The Nossal Institute of Global Health, University of Melbourne (in partnership with Public Health Foundation of India, CBM India and Uttarakhand Cluster)

2. BACKGROUND • UNCRPD, Article 31 - Statistics and data collection: • “Parties undertake to collect appropriate information, including statistical and research data, to enable them to formulate and implement policies” • Inadequate measures of access and the barriers preventing access • Many developing countries under-report disability prevalence and the needs of people with disabilities • Different definitions of disability and methods to measure disability. • .......this is not about data but about those with disability

3. Prevalence of disability Sources: United Nations Demographic Yearbook System (Nov.2006) and United Nations Disability Statistics Database (DISTAT)

4. Introduction: Why data? • What type of data is needed? • high quality, internationally comparable • Data on prevalence • Disaggregated: “Information collected in accordance with this article shall be disaggregated”Article 31 UNCRPD • Data on accessibility and barriers • Why do we need data? • If you can’t measure it, it doesn’t count (invisible) • Planning and implementation, • monitoring and evaluation of programs/inclusive policies • Advocacy for support

5. AIM & OBJECTIVES To use the RAD Household and Individual survey to measure: • Prevalence of disability in Dehradun (Uttarakhand) district • Individual perception of well‐being, and • Accessibility to services • Barriers to participation in their communities  and so inform policy, raise awareness, and promote mainstreaming

6. Study population • Dehradun District, in Uttarakhand, INDIA • Sample size: Dehradun district: 2,441 adults • 50 clusters (villages) of around 50 people

7. Methods: Sampling • Cross-sectional population-based household survey using a two-stage cluster random sampling. • 1st stage sampling: clusters randomly selected from the sampling frame using probability of selection proportional to cluster size. • 2nd stage: selecting households within clusters through compact segment sampling. • Each cases (disability) matched with control (matched age, sex) from the immediate neighbour

8. Rapid Assessment of Disability survey tool

9. Self-assessment of functioning • 16 items related to 8 domains: vision, hearing, communication, mobility, fine motor skills, cognition, appearance and mental health. • In the last 6 months, have you had difficulties seeing, even if wearing glasses? • Yes/no • How often? • Some of the time • Most of the time • All of the time • Participants responding difficulty most or all of the time to any one item of the first 7 domains and/or 2 items on mental health are considered to have a disability.

10. Community access domains • Health • Family decision making • Assistive devices • Rehabilitation services • Water and sanitation • Social activities • Religion • Government and social welfare • DPOs • Education • Disaster management

11. RESULTS

13. Prevalence of Disability • RAD study prevalence in Uttarakhand: • Functional limitation 6.92% • Mental health 4.3% • Indian Census: • Prevalence – 1.84% in Uttarakhand • Mental health - <0.1% in Uttarakhand • World Bank 2007: 6-8% • World health survey: 24.9%!

14. RESULTS: Adjusted association between socio-demographic factors and disability

15. Unmet need in those with disability versus those without disability

16. Summary of barriers from the combined domains of access

17. Difficulty in getting to the service? • Physical inaccessibility of the service? • Difficulty in getting information Inaccessible of information: can’t get to it can’t hear it, can’t see it, can’t ask about it, can’t understand it

18. The barriers for the domains with highest level of most unmet needs

19. RAD Advantages and Limitations RAD Tool Survey Advantages • Estimate number of people with disability in a community using ‘functioning’ as a measure • Identify participation and inclusion in the community • Identify barriers related to participation restrictions • Compare with those without disability (case control) RAD Tool Survey Limitations: • Not so rapid. Paper based. Data quality. • Provides a snapshot only..... NOT details on • Diagnosis of conditions (self report) • Causes of disability and factors leading to barriers to participation

20. Conclusions • Disability prevalence of 6.7% is a truer estimate than the census estimate of <2%. • Disability prevalence is higher in older, non-married, poor, uneducated and home labourers • Unmet need in participation greatest in work, health services, community consultations & rehabilitation . • The main barriers to participation: • Lack of information, lack of transport, physical inaccessibility, absence of accommodation • Family attitudes and family support not barrier • The RAD tool could be used across India to provide useful data to inform project planning and policy

21. “Bahut Dhanyavaad”! • The Public Health Foundation of India - SACDIR • Dr GVS Murthy (Co PI) • Funding partners • Australian Aid • Uni of Melbourne • CBM India – major partner -- Dr Sara Varghese, Ms Fairlene Soji, • CHGN Uttarakhand Cluster • Coordinator - Lawrence Singh • Field managers