1. The Nossal Institute of Global Health, University of Melbourne
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. UNCRPD, Article 31 - Statistics and data collection:
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
Wide variation in estimates

5. To use the RAD Household and Individual survey to measure:
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
Component of RAD
Expected Out come variables
Household questionnaire
Socio economic status and wealth index
Individual questionnaire
Adult demographics
Self-assessment of functioning
Activity limitation
Kessler’s scale
Psychological Distress
Adult well being
Adult well being scores for the people with disability and people with out disability
Access to community
Access to health, rehabilitation, Assistive devices, sanitation, Welfare services etc..among people with disability

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. Prevalence (%) Sample n=2411
RESULTS: Adjusted association between socio-demographic factors and disability
Categories
Prevalence (%) Sample n=2411
Unadjusted OR (95%CI)
Adjusted OR (95%CI)
Overall
All data
 6.8 % ( )
Age
18-24 years
3.7 ( )
1(Ref)
25-34 years
5.5( )
1.5( )
3.3( )
35-44 years
4.8(4,7-4.9)
1.3( )
2.0( )
45-54 years
5.8( )
1.6( )
3.3( )
≥ 55 years
13.7( )
4.2( )
3.8( )
Gender
Female
6.3( )
Male
8.1( )
1.3( )
1.5( )
Schooling
Yes
4.9( ) 1   1 No
15.6( )
3.2( )
2.3 ( )
Marital status
Married
5.7( )
1 (Ref)
Single
6.5( )
1.1( )
2.3 ( )
Separate/widowed/ divorced
19.3( )
3.9( )
2.5( )
Occupation
Employed
5.4( )
Homemaker
1.2(.8-1.6)
1.1( )
None
14.8( )
3.1( )
2.7( )
Socioeconomic status
Rich
2.8( )
Middle
6.1( )
2,2( )
2.6( )
Poor
9.2( )
3.5( )
4.5( )

15. Unmet need in those with disability versus those without disability
Domain
 Need (In the last 6 months, to what extent have you accessed...?)
Case (disabilit y) %
 Control (No disability %
P – value
Work
UNMET NEED
35.2
9.9 
<0.0001
Have not wanted to work for a living
26.0 
29.8
Health Services
29.7
6.4
Have not needed health services access
16.4 
33.3
Community Consultations
28.4
12.1
Have not wanted to participate
43.6
31.2
Rehabilitation Services
17.0
4.3
Have not needed to access rehabilitation
78.8 
88.7

16. Summary of barriers from the combined domains of access
TOTAL of all barriers reported
Average %
P- value
Lack of information
61.1
17.3
<0.0001
Difficulty getting to services from home, transport
48.0
8.5
0.001
Physical inaccessibility
47.7
3.6
Absence of reasonable accommodation
43.8
11.4
Cost
32.0
7.8
0.005
Absence of personal assistance to visit
31.7
8.8
0.015
Not available
24.5
7.2
0.008
Negative attitudes
24.2
4.2
0.028
Family did not want me to access
9.5
6.2
0.188

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
Disability
(Case) %
No disability
(Control) %
P- value
Place of work
Absence of reasonable accommodation
15.8
3.6
<0.0001
Physical accessibility of workplace
15.2
0.7
Difficulty getting to work from home
2.1
Lack of information about work
10.3
0.023
Negative attitudes towards you at work
7.9
1.4
0.009
Health services
Lack of information about health services
14.6
4.3
0.003
Physical accessibility of health centre
12.1
11.5
0.021
Cost of health care (e.g. doctor’s fees, meds)
10.9
0.001
Difficulty getting to health centre from home
0.002
Community Consultation
Lack of information about consultations
7.8
0.212
Difficulty getting to community meetings
0.045
6.7
0.359
Negative attitudes towards you at consultations
Physical accessibility of community meeting
5.5
0.02

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