Explanation:
Disability is an important public health problem especially in developing countries like India. The problem will increase in future because of increase in trend of non-communicable diseases and change in age structure with an increase in life expectancy. The issues are different in developed and developing countries, and rehabilitation measures should be targeted according the needs of the disabled with community participation. In India, a majority of the disabled resides in rural areas where accessibility, availability, and utilization of rehabilitation services and its cost-effectiveness are the major issues to be considered. Research on disability burden, appropriate intervention strategies and their implementation to the present context in India is a big challenge. Recent data was collected from Medline and various other sources and analyzed. The paper discusses various issues and challenges related to disability and rehabilitation services in India and emphasize to strengthen health care and service delivery to disabled in the community.
Keywords: Challenges, disability, India, issues, rehabilitation services
Introduction
Any restriction or lack of ability to perform an activity in a manner or within the range considered normal for the human beings, resulting from impairment is termed as disability. Impairment concerns the physical aspects of health; disability is the loss of functional capacity resulting from an impairment organ; handicap is a measure of the social and cultural consequences of an impairment or disability.[1] The types of disability include loco-motor, hearing, speech, visual and mental disability. Recent development is the International Classification of Functioning, Disability and Health[2] developed by WHO in 2000 which has been used in the Multi-Country Survey Study during 2000 and 2001 and the World Health Survey Program in 2002 and 2003 to measure health status of the general population in 71 countries.[3] The domains here are classified into body, individual, and societal perspectives by the conceptual components that includes body functions and structure, activity and participation along with contextual factors that includes a list of environmental and personal factors. The ICF considers that every human being can experience some degree of disability and it is a continuous process from attainable level of health. With this background, the paper discusses various issues and challenges related to disability and rehabilitation services in India.
Review of Literature
Recent data was collected from Medline and various other sources. Information gathered was summarized for Indian context and analyzed for discrepancies. Information was depicted under categories of problem burden of disability and its socio-demographic characteristics, determinants, service delivery under community-based rehabilitation, challenges ahead and recommendations to address the problem in the country.
Problem Burden
Globally, around 785-795 million persons aged 15 years and older are living with disability based on 2010 population estimates. Of these, the World Health Survey estimates that 110 million people (2.2%) have very significant difficulties in functioning while the Global Burden of Disease Survey estimates 190 million have (3.8%) have severe disability. Including children, over a billion people (about 15% of the world's population) were estimated to be living with disability.[4]
Systematic research into prevalence and determinants of disability has been scanty from India although it is an important public health problem. Disability is the best example of the iceberg phenomenon of disease. This is because of difficulty in identifying the mild and moderate degrees of physical and mental disability which are unrecognized by the health care delivery system and the survey team members.[5] The WHO estimates that 10% of the world's population has some form of disability.[6] In contrast, the National Sample Survey Organization (NSSO) report[7] and Census data of 2001[8] stated that its prevalence was as low as 2% in India. A recent community-based study in India found the prevalence of all types of disability as 6.3% out of which mental disability was found to be the most common type of disability (36.7%).[9]
