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Figure 6.2
Outcomes of RCH-II
Source: Reproductive and Child Health Programme-II, Third Joint Review Mission, January 15-February 8, Ministry of Health and Family Welfare, GoI, 2007, page 8.
6A.3 Challenges
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The Government is continuously strengthening child-health services, which include universalisation of ICDS in the 11th Five Year Plan; adoption of holistic approach through Integrated Management of Neonatal and Childhood Illnesses (IMNCI); launch of second phase of RCH; and launch of the National Rural Health Mission (NRHM). (See Section 6C.3 for details.)
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The following are the key challenges related to survival and development of children:
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High levels of neonatal mortality, which contribute to about 50% of all childhood deaths. For this, focused efforts are being made to address the key causes and determinants of neonatal mortality through interventions on continuum of care.
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High levels of under-nutrition, particularly in the States of Madhya Pradesh, Bihar, and Jharkhand.
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To improve access to food and knowledge of appropriate feeding care practices and services, especially among vulnerable population. Focused behaviour change communication efforts are underway to improve key new-born and child-care practices at the community level.
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To improve access and questionable quality of public health services in certain regions. Government efforts are focussed on scaling up and improving the quality of services by expansion of NRHM and IMNCI and improved monitoring.
6B. Children with Disabilities
Article 23
6B.1 Status and Trends
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The Census of India, which provides data on disability, is available for the year 2001, and the next Census will be taken up in 2011; thus, the reporting period does not have new data to show changes in the status of Children with Disabilities (CWDs). (See Section 3B.3.1 for details.)
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India has made progress in reducing the incidence of specific diseases leading to disabilities, such as polio. (See Section 6C.1.7 for details.) It is estimated that more than 71 million persons are suffering from goitre, and other Iodine Deficiency Disorders (IDDs).1 Iodine deficiencies could result in abortions, still-births, mental retardation, deaf mutism, squint, goitre and neuromotor defects.
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Disability arising from maternal causes is difficult to assess and estimate, but it is well known that premature births, low birth weight, maternal anaemia and malnutrition increase the risk of disability among babies. The prevalence of Neural Tube Defects (NTDs) is reported to be 3.63 per 1,000 live births. It can result in major and irreversible disabilities in infant neonates, and can be prevented by including folic acid supplements in the diet of pregnant women. The prevalence of NTDs is particularly high in the northern States of Punjab, Haryana, Rajasthan and Bihar.
6B.2 Policy
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The National Policy for Persons with Disabilities (PWDs), 2006, provides for prevention of disabilities and includes rehabilitation measures. (See Section 1.2 for details.) Initiatives have also been taken by MoH&FW to prevent disabilities. In order to check disorders caused by iodine deficiency, MoH&FW issued a notification, banning the sale of non-iodised salt for direct human consumption in the entire country with effect from May 17, 2006. (See Section 3B.3.2 for details.)
6B.3 Legislation
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The Government has initiated steps to amend the Persons with Disabilities (Equal Opportunities, Protection of Rights and Full Participation) Act, 1995, to harmonise with UN Convention on the Rights of Persons with Disabilities (UNCRPD) ratified by India in 2007. The amendments propose to comprehensively cover all kinds of disabilities and more specific obligations of the States and local authorities. (See Section 1.4.3 for details.)
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The Juvenile Justice (Care and Protection of Children) (Amendment) Act, 2006, (JJ (Amendment) Act, 2006), provides for care and protection of children with disabilities. The National Trust for Welfare of Persons with Autism, Cerebral Palsy, Mental Retardation and Multiple Disabilities Act, 1999, has provisions to enable and empower PWDs. (See Section 3B.3.3 for details.)
6B.4 Programmes
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Several schemes are being implemented by various Ministries for empowerment and rehabilitation of PWDs. These schemes aim at promoting physical, psychological, social, educational and economic rehabilitation and development of PWDs to enhance their quality of life and also enable them to lead a life with dignity.
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The major schemes of the Ministry of Social Justice & Empowerment (MSJ&E), which is the nodal Ministry, include:2
(i) The Scheme of Assistance to Disabled Persons for Purchase/Fitting of Aids/Appliances (ADIP) provides assistive devices. Approximately 0.2 million PWDs have been provided assistive devices under the Scheme. Under Sarva Shiksha Abhiyan (SSA), assistive aids and appliances are distributed to school children below 14 years of age.
(ii) The Deendayal Disabled Rehabilitation Scheme includes projects for providing education and vocational training, and rehabilitation of persons with orthopaedic, speech, visual and mental disabilities. The services provided under the Scheme include: programmes for pre-school and early intervention, special education, vocational training and placement, community-based rehabilitation, etc.
(iii) The Scheme for Implementation of PWD Act, 1995: Under this Scheme, Grant-in-aid is provided to various bodies set up by the Central Government and State Government, including autonomous bodies and universities, to support activities related to implementation of the provisions of the PWD Act, 1995. The range of activities, for which grant-in-aid is provided with regard to barrier-free access, is wide, including ramps, lifts, tactile paths, new product development and research.
(iv) There are schemes to support various organisations of the Ministry that are involved in different aspects of rehabilitation of PWDs, such as Artificial Limbs Manufacturing Cooperation of India, Rehabilitation Council of India and National Handicapped Finance and Development Corporation.
(v) The National Fund for PWDs is implementing a scholarship scheme for students with disabilities, under which 500 new scholarships are awarded each year for four major categories of disabilities: orthopaedic, visual, hearing and others. Further, 40% of the scholarships in each category are reserved for girls.
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A pilot project for creation of awareness on prevention and early detection of various types of disabilities in children has been developed by the MSJ&E. The project envisages dissemination of information about disabilities in rural areas through Anganwadi Workers (AWWs). The project is to be taken up in 30 Districts of the country (17 in Uttar Pradesh and 13 in Bihar). A similar programme is being taken up in 13 Districts of Assam.3
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Consequent to the enactment of the PWD Act, 1995, a scheme of setting up Composite Regional Centre was formulated, which is a part of overall strategy to reach out to PWDs and to facilitate the creation of the required infrastructure and capacity-building at central, State and District levels, and even below, for awareness generation, training of rehabilitation professionals, service delivery, etc. At present, there are six Composite Regional Centres functioning in the country. The Ministry, with support from State Governments, is also facilitating creation of infrastructure and capacity building at District level for awareness generation, rehabilitation, training and guiding of grassroot-level functionaries by setting up District Disability Rehabilitation Centres (DDRCs) in all the unserved Districts of the country.
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The State Nodal Agency Centres (SNACs) are leading Non Governmental Organisations (NGOs) and nodal agencies in each State, and supporting them are State Nodal Agency Partners (SNAPs), each networking in 10 Districts in the larger States. The activities of SNACs/SNAPs include sensitising families, PWDs and other related professionals and community members; training private school teachers to handle the special needs of students; facilitating formation of Parent’s Association and Disabled People’s Organisation, etc. The National Trust for the Welfare of Persons with Autism, Cerebral Palsy, Mental Retardation and Multiple Disabilities specifically focuses on early intervention. Under its Aspiration Scheme, day-care centres have been set up for children upto six years with developmental disabilities, to make them ready for mainstream and special schools.
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Besides MSJ&E, other Ministries are also implementing programmes/activities related to disability. The ICDS, implemented by the Ministry of Women and Child Development (MWCD), addresses prevention of disability by reaching out to children below six years, through early childhood health and nutrition interventions. The ICDS network is vigorously working for prenatal and postnatal care of mother and child, pre-school education and awareness through Anganwadi Centres (AWCs). In 2008, the MWCD adopted the new WHO Child Growth Standards under the ICDS for monitoring the growth of children. The proposed Rajiv Gandhi Scheme for Empowerment of Adolescent Girls aims to improve the nutritional and health status of adolescent girls. (See Section 6C.3.2 for details.) The Integrated Child Protection Scheme (ICPS), launched by the MWCD, provides for a safe and secure environment for overall development of children in need of care and protection, including CWDs. The Scheme’s primary focus is on integrating services for children with special needs in existing institutional services, such as children’s homes and special homes. It also provides for a separate home for such children in a situation, where there are a large number of children with special needs, in a District or group of Districts.
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The MoH&FW is also implementing programmes to address disability. These include the National Programme for Control of Blindness, which addresses reduction in the prevalence of blindness; the National Leprosy Eradication Programme, focusing on early detection and prompt treatment of leprosy to prevent disability; the Urban Leprosy Control Programme, which addresses the complex problems related to leprosy control in urban areas like larger population size, migration and poor health infrastructure that increase prevalence of the disease; and the National Iodine Deficiency Disorders Control Programme, which includes surveys to assess the magnitude of IDDs and the impact of control measures, supply of iodised salt in place of common salt and Information, Education and Communication (IEC) materials.4 In order to monitor the quality of iodised salt and urinary iodine excretion, 18 States/UTs have set up IDD monitoring laboratories, while the remaining States are in the process of establishing the same. Since its inception in 1995, the Pulse Polio Immunisation Programme of the Ministry has achieved significant success in reducing the number of polio cases in the country. The annual strategy for polio eradication is decided on the basis of the recommendations of the India Expert Advisory Group (IEAG), consisting of national and international experts from WHO, UNICEF and the Centre for Disease Control and Prevention, Atlanta. The IEAG reviews the polio epidemiological situation twice a year and recommends suitable strategies for the country. The National Polio Surveillance Project of WHO provides technical support for high-quality acute flaccid paralysis surveillance, and assists the Government in micro planning, training and monitoring of polio immunisation campaign.5
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The Ministry of Rural Development provides for 3% reservation for PWDs in major poverty-alleviation programmes under the National Rural Employment Guarantee Act (NREGA), the Swarnjayanti Gram Swarozgar Yojana (SGSY) and the Indira Awaas Yojana (IAY).6
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The SSA, a flagship programme of the Ministry of Human Resource Development (MHRD), has specific interventions for inclusive education, such as identification, functional and formal assessment, appropriate educational placement, preparation of Individualised Educational Plan, provision of aids and appliances, teacher training, resource support, removal of architectural barriers, research, monitoring and evaluation and a special focus on girls with special needs. SSA ensures that every child with special needs, irrespective of the kind, category and degree of disability, is provided meaningful and quality education. Hence, SSA has adopted a zero-rejection policy. The measures include special schools, Education Guarantee Scheme (EGS), Alternative and Innovative Education (AIE) and even home-based education. Convergence has also been established with the MSJ&E to provide aids and appliances to CWDs under SSA. The Scheme of Inclusive Education of the Disabled at Secondary Stage (IEDSS) enables students with disabilities to complete secondary and higher secondary education, and also supports a training programme on inclusive education for general school teachers.
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In addition, several States are taking up initiatives for the prevention and early detection of disabilities through the Department of Health and Family Welfare or through the SSA. For example, in West Bengal, efforts are being made through sensitisation of AWWs and orientation of community leaders and teachers of primary and upper primary schools to integrated education for disabled (IED) issues, including early detection and prevention of disabilities, training of key resource persons from the family of CWDs, and parental counselling through home visits, etc. (See Annexure 6B.1 for State initiatives for children with disabilities.)
6B.5 Resources
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In 2008-09, the percentage of expenditure on disabilities in the nodal Ministry (MSJ&E) to the total Government of India expenditure was 0.03%.7 While spending under other Ministries may have risen in some cases, the MSJ&E does not have figures of expenditure incurred on PWDs from other Ministries, such as the Ministry of Health and Family Welfare, the Ministry of Human Resource Development, the Ministry of Women and Child Development, etc.8 The information on trends in resource allocation and percentage increase in number of beneficiaries since 2002-03 is given in Table 6.1.
6B.6 Awareness Generation
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Various awareness campaigns are being organised by the Information and Mass Education Cell of MSJ&E, through the print, electronic and folk media. On December 3, the International Day for PWDs is commemorated, with organisation of events related to sports, games, debates, workshops and cultural programmes in several States.
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State Governments organise sensitisation camps regularly at the Municipal Corporation, Sub-Divisional, Divisional, and District levels. Books on relevant Acts/ Rules related to disability have also been printed in local languages, and distributed to diverse stakeholders such as NGOs, teachers and community-based workers.9
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