Rapid Assessment of Disability (RAD) Development of an instrument to support disability inclusive development Ms. Alexandra Devine 6 December 2011 On behalf of the research team: Prof. Jill Keeffe, Ms. Sally Baker, Ms. Tanya Edmonds, Dr. Manjula Marella, Dr. Lucy Busjia, Dr. Nicolas Goujon, Ms. Beth Sprunt, Dr. Nafisa Lira Huq, Dr. Biu Sikivou, Dr. Anaseini Cama, Ms. Jenny Booth and Ms. Kathy Fotis,

Background Article 32 of the United Nations Convention on the Rights of Persons with Disabilities (CRPD) states all international development assistance programs must be inclusive of people with disabilities Several international donors, including AusAID, and implementing agencies have written policies and made broad commitments to mainstream disability across their development programs.

Why do we need the Rapid Assessment of Disability? Implementers increasing understanding of WHY they need to include people with disabilities in development activities But there is limited knowledge and experience on HOW: –Limited reliable and comparable data about people with disabilities in low and middle income countries –Limited knowledge of how to include people with disabilities and their priorities in program design, implementation, and outcome –Paucity of instruments that can: Determine prevalence and baseline information on disability in communities AND Support efforts to design and measure the effectiveness of disability inclusive development programs in rights based, rapid, easy to use way

Addressing the challenge: The Australian Agency for International Development (AusAID) has funded the development of the Rapid Assessment of Disability (RAD) toolkit: Collaboration between the University of Melbourne’s Nossal Institute for Global Health and the Centre for Eye Research Australia In country collaborators ICDDR,B (Bangladesh), Pacific Eye Institute (Fiji) Collaborations with a number of Disabled Persons Organizations in both Bangladesh and Fiji

Methods: Conceptual framework: ICF and UNCRPD Ensure the research is participatory and inclusive of people with disabilities across the project cycle Literature review of existing tools: –WCG Long and Short set –ICF Checklist/ Questionnaire –WHO DAS II 12 and 36 Items –ALS/PRS –NDSA Screening, Health and Extensive Set –Participation Scale –WHOQOL- BREF –CHIEF Long and Short set –UNICEF 10Q –PedsQL 4.0 –Kessler 6 Workshop technique to group items under the ICF and identify gaps

The RAD toolkit: A household survey (socio-economic items) A questionnaire with 5 sections to measure: 1.Demographic information 2.Assessment of functioning 3.Individual perception of rights 4.Well-being and quality of life, 5.Participation of people with disabilities in their community Questionnaire developed for 3 age groups; 0-4yrs, 5- 17yrs, >17yrs Guidelines on how to use the toolkit, including recommendations for different sectors (education, health, WASH, livelihoods, law and justice etc) will be written

Methods: Bangladesh and Fiji Qualitative study: group discussions and in depth interviews Recruitment and training: data collectors with and without disabilities Pre-testing with a convenience sample of 60 people with and without disability Field testing: population-based randomly selected clusters –Household survey households, 66 clusters –Interviewed 2897 people on demographics and assessment of functioning –Identified 195/1855 adults with impairment and 195 matched controls to complete longer questionnaire Data analysis including Rasch analysis to conduct preliminary validation and refine questionnaire Field testing with a purposive sample with a target of 200 people with disabilities and 200 people without disability Further analysis of data and finalise questionnaire

Results from Bangladesh Prevalence differed according to how people were questioned regarding their disability / functioning: - Section 1: Do you have a disability? 54/1855 (2.9%) responded ‘Yes’ Section 2: assessment of functioning identified 195 people with impairments (10.5%): –128 (65.6%) said ‘No’ to ‘Do you have a disability’ –40 (20%) said ‘Yes’ As expected the proportion of people with impairment increased with age –From 5.6% among year olds to 43.1% in the ≥ 55 years age group

Factors Adjusted Odds Ratios (95%Confidence Intervals) Gender Male0.97 (0.48, 1.94) Female1 Age (years) ≥ (4.11, 20.41) (2.97, 14.19) (2.17, 10.89) (0.90, 4.67) Socio-economic status Poor2.11 (1.25, 3.56) Middle1.15 (0.65, 2.05) Rich1 Education None1.00 (0.45, 2.25) 1-4 years1.17 (0.50, 2.71) 5-9 years1.08 (0.47, 2.45) 10 years or more1 Occupation None3.99 (2.19, 7.28) Farmer0.67 (0.28, 1.56) Daily wage labourer0.90 (0.39, 2.09) Professional/businessman1.05 (0.39, 2.83) Homemaker1 Predictors of impairment Prevalence of impairment increased with age and was higher among people in ‘poor’ socio-economic status and with no occupation.

Descriptive findings from Bangladesh cont People with disabilities were less likely to be unemployed –26.6% people with disabilities were unemployed versus 8.9% of people without disabilities (p<0.0001) People with disabilities reported poorer well-being –Poverty and unemployment independent predictors of poor well-being among people with disabilities Attitudes regarding the rights of people with disabilities were generally negative.

Descriptive findings from Bangladesh cont People with disabilities generally participate less in all areas of life reporting more barriers to education, work, health services, community consultation, assistive devices, rehabilitation services –48.8% of people with disabilities had no education versus 35.0% of people without disabilities –Barriers to education included: »Family did not want me to go to school (51.5%) »Cost (35.9%) »Physical accessibility of the schools (2.9%) »School did not allow me to attend (1%)

Conclusions A tool which can support disability inclusive development is eagerly awaited by many development and disability stakeholders across the world. A questionnaire which can meet the complex objectives of this project can be considered “rapid” in terms of the methodology The process of utilising an inclusive, rights based approach in research provides opportunity for awareness raising, and, can result in new, longer term employment opportunities for people with disabilities within mainstream organisations. Next stage, after implementation in Fiji, trial the RAD in collaboration with development sector with the aim of contributing to the evidence about effectiveness of disability inclusive development.

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