Journey of Hope (A report - NOWPDP

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6.7 Resource Mobilization6.8 Provision of Suitable Facilities and Services

SECTION 7 ANNEXURESAnnex I: Recommendations of Focus Group Discussion at

Peshawar (April 2, 2008)Annex II: Recommendations of Focus Group Discussion at

Lahore (April 5, 2008)Annex III: Recommendations of Focus Group Discussion at

Karachi (April 8, 2008)Annex IV: Recommendations of Focus Group Discussion at

Islamabad (April 12, 2008)Annex V: List of Participants of the Focus Group Discussion at

Peshawar (April 2, 2008)Annex VI: List of Participants of the Focus Group Discussion at

Lahore (April 5, 2008)Annex VII: List of Participants of the Focus Group Discussion at

Karachi (April 8, 2008)Annex VIII: List of Participants of the Focus Group Discussion at

Islamabad (April 12, 2008)Annex IX: References

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PREFACEResearch Report: Journey of Hope (A report on the status of persons with

disabilities in Pakistan and the way forward)

According to the 1998 Pakistan census, approximately 2.49 percent of the population has some form of disability.Translated in absolute numbers, nearly 3.2 million people in Pakistan are disabled out of which 1.37 million are femalesand 1.99 million males; while 37.2% fall in 0-14 age group. In Pakistan persons with disabilities are still subjected toconventional exclusion and extreme stigmatization while globally there is a greater acknowledgement that most personswith disabilities have the potential to become responsible and self reliant members of society.

It is in this context that this research report has been prepared under a Programme of The Aga Khan Council forPakistan for bringing about positive changes in the social attitudes toward persons with disabilities and paving the wayfor an equal and inclusive world. The Programme—one of a series of several different thematic programmes being heldto foster awareness of modern-day issues facing the Ummah—is being held during the year that commemorates theGolden Jubilee of the Imamat of His Highness the Aga Khan. It is expected that this programme, the Journey of Hope,will inform key publics, lead to greater awareness, and result in concrete steps to improve the opportunities for personswith disabilities in the educational, economic, social and cultural domains of their lives.

The report has been produced in collaboration with the National Commission for Social Welfare of the Government ofPakistan and with input from major institutions and organisations working with people with all forms of disabilities. Thedraft report was peer reviewed at four Focus Group Discussions organized at Peshawar, Lahore, Karachi andIslamabad during April 2008, with over one hundred such institutions participating.

The report situates the existing status of persons with disabilities and the organizations working with them, analysesexisting policies and laws, highlights the challenges faced by both these individuals as well as these organizations, andgives concrete suggestions for addressing the stated challenges.

The most important and immediate outcome of the report is the launch of a Network named ‘”Network of OrganizationsWorking for People with Disabilities, Pakistan”, (NOWPD,P). Participants of the four Focus Group Discussions cited theabsence of such a network as a major impediment in their efforts to foster an enabling policy environment addressingthe needs of persons with disabilities. Hence, it is expected that the Network would facilitate these organizations in thisregard.

The report would not have been completed in its present form without the hard work of several institutions andindividuals who deserve special mention. The whole exercise was led by a special Task Force of the Aga Khan Councilfor Pakistan. Additionally, lead authors were Malik Mumtaz Hussain, Rana Mukhtar Ahmad and Syed Izhar Hussainunder the guidance of Rais Jahangir Ahmad, Chairman, National Council for Social Welfare. Gul Najam Jamy of AgaKhan Foundation (Pakistan) provided support through the conduct of Focus Group Discussions and liaison with variousinstitutions for the timely completion of the report. Habi Shariff of the Government of Alberta and Keith Turton fromMental Health First Aid Canada, Alberta Mental Board, Canada undertook a detailed review of the report in a volunteercapacity.

I anticipate that this report will lead to several new initiatives. On its part, the Aga Khan Council for Pakistan is committed

Iqbal . S. WaljiPresidentHis Highness the Aga Khan Council for Pakistan

to take forward some key actions, foremost among them being the launch of Network.

Acronyms

ADL Activities of Daily Living

AIDS Acquired Immune Deficiency Syndrome

AIOU Allama Iqbal Open University

AJK Azad Jammu & Kashmir

AMC Army Medical Corps

ARPDAssociation for Rehabilitation of PhysicallyHandicapped

CBO Community Based Organisation

CBR Community Based Rehabilitation

CWDs Children with Disabilities

DGSE Directorate General of Special Education

DHQ District Head Quarters

DISTAT Disability Statistics Database

DPOs Disabled Persons Organizations

EFA Education for All

FANA Federally Administered Northern Areas

FBS Federal Bureau of Statistics

GOP Government of Pakistan

HHD High Human Development

HI Hearing Impairment

HQ Head Quarter

ICD International Classification of Diseases

ICT Islamabad Capital Territory

ICIHDInternational Classification of Impairments,Disabilities and Handicaps

IYDP International Year of Disabled Persons

LABAD Lahore Business Association of Disabled

LCCI Lahore Chamber of Commerce and Industry

LHD Low Human Development

LHWs Lady Health Workers

MHD Medium Human Development

MR Mental Retardation

MDGs Millennium Development Goals

MTDF Medium Term Development Framework 2001-10

NCRDPNational Council for Rehabilitation of DisabledPersons

NGO Non-Governmental Organization

NIH National Institute for Handicapped

NIRM National Institute for Rehabilitation Medicine

NPA National Plan of Action

NRSP National Rural Support Programme

NWFP North West Frontier Province

PCO Pakistan Census Organization

PCRDPProvincial Council for Rehabilitation of DisabledPersons

PH Physical Handicap

PHC Primary Health Care

PIDE Pakistan Institute of Development Economic

PRSP Provincial Rural Support Programme

PWDs Persons With Disabilities

SE Special Education

SED Special Education Department

SMEDA Small Medium Enterprises Development Agency

ST Scheduled Tribe

STD Sexually Transmitted Disease

UNSO United National Statistical Office

VH Visual Handicap

VR Vocational Rehabilitation

VREDPVocational Rehabilitation Employment ForDisabled Persons

WHO World Health Organization

Executive Summary

This report is based on secondary data available in the country on the prevalence ofdisability, challenges faced by persons with disabilities (PWD) and organizations working forthem and possible initiatives to address these challenges. The report was finalized through aseries of focus group discussions at Peshawar, Lahore, Karachi and Islamabad.

Conceptual Framework

This section of the report addresses the conceptual framework including definitions,classification and causes of disabilities. The ICIDH framework is technically termed as a bio-psychosocial model. It gives a very broad spectrum conceptualization of disability andreflects a paradigm shift from medical model to, in common parlance, a socio-economicmodel. It describes three important components that constitute disability which include(i) health condition (disease/disorder), (ii) personal activities and (iii) participation in societyand it also takes into account the environmental, personal and institutional factors.

Magnitude of the Problem in Pakistan

This section focuses on prevalence of disability. In Pakistan, despite the evidence ofinclusion of disability in the national census, statistics on disability suffer from inadequaciessuch as lack of standardized definitions. The WHO estimate of disability for the developingcountries was found to be 10% of the total population. These were, however, not confirmedduring the survey of disability of twin cities of Rawalpindi / Islamabad carried out by theDirectorate General of Special Education during 1985-86. The Pakistan Census Organizationin its census carried out in 1998 estimated a population of PWDs 3.293 million against thetotal population of 132.352 million that constitutes 2.49% of the population.

Development of Special Education Programmes in Pakistan

This section provides a situation analysis of existing education, training and rehabilitationservices and facilities for PWDs and students enrolment. There were only few institutions atthe time of independence which reached up to 531 units in 2006. A sharp rise in the pace ofdevelopment of institutions for PWDs was witnessed after the observance of InternationalYear of the Disabled Persons (IYDP), 1981 which was followed by the establishment ofDirectorate General of Special Education in 1985. A variety of institutions during the decade1980-1990 were established including the construction of purpose built premises. Theexisting institutions are catering to the educational needs of only 4% of the children of schoolgoing age. The data transpires that there is an acute shortage of vocational training facilitiesfor PWDs. Rural areas with nearly 3/4th of the population are largely neglected and dependupon the local treatment through traditional healers in their localities.

Legislation and Policy Reforms

This section highlights the measures adopted by the government for the welfare of PWDswhich include promulgation of the ‘Disabled Persons (Employment & Rehabilitation)Ordinance, 1981’ that provides the reservation of one percent employment quota,establishment of welfare fund for PWDs and establishment of National and ProvincialCouncils for the Rehabilitation of the Disabled. The other policy reforms include NationalPolicy for the Persons with Disability and formulation of a National Plan of Action (NPA)for the PWDs to achieve the objectives and goals laid down in the policy. The DGSErecently took an initiative to develop an accessibility code for buildings.

Major Challenges and Constraints

This section identifies the challenges and constraints faced by PWDs and organizationsworking for them which include:

absence of coordination and networking mechanisms;lack of reliable data;inappropriate need assessment;inadequate policy, legislative and enforcement framework;lack of community based programmes;shortage of human resource;inadequate resources;insufficient services and facilities (such as sheltered workshops, barrier freebuildings, micro-credit facilities and equipment).

Proposed Initiatives to Address the Challenges

This section suggests a variety of initiatives to address the challenges identified. Mostnotable among them are:

establishment of a national network for organizations working for persons withdisabilities;collection of reliable data;conduct of scientific needs assessment;improvements in policy, legislative and enforcement framework;enhanced community based programmes;human resource development;resource mobilization;provision of better services and facilities.

Section 1: CONCEPTUAL FRAMEWORK

1.1 Disability: A Connotation

This section addresses two overarching themes which recur in the report. A brief discussionof each is useful by way of framing the main body of the report. The themes are: (i) modelsof disability; and (ii) a framework for public policy and disability.

(a) Models of Disability1

Virtually all new literature on disability outlines the shift in disability policy thinking fromthe charity and medical models of disability towards social model of disability. Thevarious models can be described briefly as follows:

• The medical model of disability relies on a purely medical definition of disability. Itthus equates the physical or mental impairment from a disease or disorder with thedisability that the person experiences. From a policy viewpoint, the person withdisability is viewed as the “problem”, and in need of cure and treatment. In terms ofservices, the general approach within this model is towards special institutions forpeople with disabilities, e.g. special schools, sheltered workshops, special transportetc. The limitations of the pure medical model are evident, though it underlies somecurrent analysis such as that based on disability-adjusted life years (DALYs);

• The charity model of disability also views the person with disabilities as theproblem and dependent on the sympathy of others to provide assistance in a charity orwelfare mode;

• The social model of disability “places the emphasis on promoting social change thatempowers and incorporates the experiences of PWD, asking society itself to adapt”.The social model emphasizes institutional, environmental and attitudinaldiscriminations as the real basis for disability. Thus it is the society at large whichdisables the person with disabilities through discrimination, denial of rights, andcreation of economic dependency; and

• The rights-based model of disability builds on the insights of the social model topromote creation of communities which accept diversities and differences, and have anon-discriminating environment in terms of inclusion in all aspects of the life ofsociety.

It took time to build consensus on a conceptual framework which reflected dimensions ofdisability beyond the medical. The International Classification of Impairments, Disability andHandicaps (ICIDH) from WHO in 1980 was a breakthrough in this evolution. It recognizedthat personal, social and environmental factors are all at play in “creating” disability. This

1 This section draws from: People with Disabilities in India: From Commitments to Outcomes, May 2007,World Bank; Metts (2000) and input from Allana, see DFID-1997

acknowledged that not only physical or mental impairments but the attitudes and institutionsof society had significant impacts on the opportunities of PWDs.

The ICIDH-2 from 1997 represents a further step in this process. It defines disability as: “.anumbrella term covering three dimensions: (i) body structures and function; (ii) personalactivities; and (iii) participation in society. These dimensions of health-related experience aretermed “impairments of function and impairments of structure”, “activities” [i.e. nature andextent of individual functioning due to impairments], and “participation” [the nature andextent of a person’s involvement with life situations] respectively”.

While the language of ICIDH-2 is dense, the intuition is simple. Limitations on PWDsparticipation in the life of their society are created by the interaction of generalenvironmental factors (e.g. the structural environment; societal attitudes), individual-specificfactors (e.g. gender, age or education), and the impairment(s) that the individual has. TheICIDH-2 is sometimes termed a bio-psychosocial (or, socio-economic) model of disability.The model is presented in diagrammatic form in figure below:

The ICIDH-2 Framework for Understanding Disability2

Health Condition(disorder / disease)

Impairment Activity Participation

Contextual FactorsA. EnvironmentalB. PersonalC. Institutional

The analysis of the literature on disability reveals that a unified understanding of the conceptor definition does not exist among service providers i.e. surgeons, physicians, specialeducators and representatives of NGOs. Classification of disabilities and standards offunctional disabilities in their broader manifestation were found to be vague that can beattributed to some extent to international or political pressures to certify individuals fordisability with benefits including employment quota for the persons with disabilities.

2 This Section Draws from Metts (2000) and input of Allana, see DFID -1997

Within the International Classification of Impairments, Disabilities and Handicaps (ICIDH)framework disability/disablement is an umbrella or broad spectrum term that includes threeimportant dimensions:

(i) Body structure and functions(ii) Personal activities, and(iii) Participation in society

This conceptualization of disablement comprises three separate and interrelated componentswhich are impairments, disabilities and handicaps. Any impairment caused by a disease ordisorder resulting in disability may lead to handicap. Disability has been defined asrestriction or lack of ability to perform an activity in a manner or within the range considerednormal for a human being. Disabilities are caused by impairments which are defined as losesand abnormalities of psychological, physiological or anatomical structure or function.Impairments and disabilities are both casually linked to handicaps that limit or prevent thefulfillment of a role considered to be normal depending upon the age, gender, social andcultural facilities.

In Pakistan, the National Policy for the Persons with Disabilities, 2002 defines disability aslack of ability to perform an activity in a manner considered to be normal. The DisabledPersons (Employment and Rehabilitation) Ordinance, 1981 defines the disabled person assomeone who on account of injury, disease or congenital deformity, is handicapped forundertaking any gainful profession or employment in order to earn a livelihood, and includespersons who are blind, deaf, physically handicapped or mentally retarded. The disease is aphysical or mental condition arising from the imperfect development of an organ. Thesedefinitions by and large are close enough to the international standards but certainly need tobe further reviewed and modified to bring them into conformity with the changing needs ofthe time and international conventions.

1.2 Classification of Disabilities3

There have been numerous attempts to devise disability classification systems in the UnitedStates, in part because of the rise of social insurance programs such as workmen’scompensation, veterans’ benefits, and social security programs. Disability measures havealso been problematic as public policy making tools. The eligibility criteria of the nation’ssocial security insurance programs have been criticized for relying on the narrowly definedcriteria of the disease to determine disability. Another important source of disabilityclassification has been health interview surveys. From the time of their introduction to theUnited States, these surveys have grown increasingly sophisticated, and by the 1950s Katzand Lawton had developed short sets of survey questions based on behavioural theories ofhuman function. These indexes are known as the Activities of Daily Living (ADL), whichmeasure abilities in six functions (bathing, dressing, toileting, transfer, continence, andfeeding). Despite their widespread use, however, each of the classification systems that havecome into use in USA suffers from limitations of one kind or another. These limitations have

3 Situation Analysis, M/S Arjumand Associates, 2004

been recognized and other forms of classifications including efforts to combine thesemeasures have been attempted, but there has been no consensus on a system that couldprovide a sufficiently broad understanding of disability. These and other specific measuresprovide insight into the way the disability affects important parts of most people’s lives, buttheir scope is too narrow. Moreover, health care measures are now called on to assess thequality of life, but without a fuller perspective on the effects of disability, such classificationand measurement systems do not have a convincing claim to make such assessments.

In the search for solutions, epidemiologists, demographers, physicians, insurers, and otherhealth-related professionals have looked into classification systems that attempt to provide acomprehensive framework for understanding and acting on both the physical and socialdimensions of disabilities. Several attempts have been made to classify a broad range ofdisability phenomena into categories organized according to various levels, from thepathological to the individual to the social, on which disabling conditions exist. The WorldHealth Organization’s International Classification of Impairments, Disabilities, andHandicaps (ICIDH) is widely used and frequently discussed. It addresses somatic, cognitive,economic, and psycho-social dynamics. The ICIDH system categorizes a wide range ofdisease consequences and suggests points of intervention (to prevent further development)and forms of assistance to help individuals cope with their difficulties. The form andorganization of the system are similar to WHO’s International Classification of Diseases(ICD) especially in many of its subcategories; the overall structure, however, is informed bya theory of “planes of experience” in the development of illness and disability. This gives riseto four main categories: disease/disorder, impairment, disability, and handicap.

The disabilities in Pakistan are generally categorized as: (i) physical handicap; (ii) hearingimpairment; (iii) visual impairment; and (iv) mental retardation. These are again classifiedas; (i) mild; (ii) moderate; and (iii) severe / profound, depending upon the extent of loss orfunctional deformity.

In the special education context, physical disability or orthopaedic impairment includessevere disabilities that adversely affect educational performance. There is a wide range ofdisabilities in this category including such conditions as cerebral palsy, spina bifidaamputations or limb abscess and muscular dystrophy. There are also a variety of healthrelated problems which are termed as special health impairments that require special medicalcare and educational services. Health impairments include convulsive disorder, cysticfibrosis, heart disease sickle cell disease, haemophilia, asthma, rheumatic fever, cancer,AIDS or any other chronic or acute health condition that limits strength vitality and alertnessthat adversely affect the educational performance.

Visual impairment refers to total blindness, partial visual impairment or low vision. It may bedue to hereditary factors or because of any infection, disease, head injury or pressure on opticnerve or other retinal disease.

Hearing impairment refers to deafness that varies according to the extent of hearing loss thatcan easily be assessed through a procedure of audiometry.

Mental retardation is different from mental sickness or psychological functional disordersarising from worries, anxieties and tensions that may lead to acute depression, neurosis,psychosis or mental diseases like schizophrenia. Defining it as what it is rather than what it isnot would be preferable.

The task relating to the assessment of disability in Pakistan has been assigned to DisabilityAssessment Boards constituted at the District Headquarter Hospitals under the Chairmanshipof Medical Superintendent for issuing a certificate to persons with disabilities seeking jobs.

1.3 Causes Of Disabilities4

There are numerous known causes of disabilities but in a great number of cases exact causeof impairment is never known. Several causes may combine to create a disability. There are,however, two major causes of disabilities: biomedical/constitutional and socio-cultural orenvironmental. Biomedical causes have their origin within the body of the individualwhereas socio-cultural and environmental causes of disabilities are those that originateoutside the individual’s body. This includes not only those stemming from the social, culturaland physical environment but also those causes that result from the individual’s life-style andbehaviour.

Disabilities can originate at any stage of life: prenatal, perinatal, neonatal infancy, earlychildhood, adolescence, adulthood and old age.

1.3.1 Prenatal Causes

The prenatal period extends from conception to the time of birth. Disabling conditions canoccur at any point in the developmental process between those two events. Some prenatalbiomedical causes of disability involve the basic building blocks of life: the genes andchromosomes that the person inherits. Other handicaps result from the prenatal environmentwithin the womb. These causes can be considered separately, but it should be realized thatheredity and prenatal environment work together to produce the infant. In some cases, FetalAlcohol Spectrum Disorder caused by drinking by the mother also causes disability in thenewborn,

1.3.2 Chromosomal/Genetic Causes

Chromosomal abnormalities can involve the loss, gain, or exchange of genetic material froma chromosome pair. Such abnormalities often cause miscarriages, but may occasionally resultin a baby with some kind of disability. Down’s syndrome, a congenital condition that usuallyincludes physical health problems and mental retardation, is caused by an abnormality of thechromosomes. The twenty-first chromosome set is a triplet instead of a pair, hence the othername of this syndrome, Trisomy 21. Down’s syndrome is often associated with the mother’sage. The incidence rate is high when mothers are extremely young, low for mother in earlyadulthood, and increases with the mother’s age after 35. Some of the more disabling

4 Situation Analysis, M/S Arjumand Associates, 2004

conditions caused by the genetic / hereditary / chromosomal abnormalities are brieflyexplained below:

1.3.3. Retinitis Pigmentosa (RP)

It is one of the eye disorders and is a genetically transmitted hereditary eye disease.Symptoms of Retinitis Pigmentosa usually appear in children and gradually lead to loss ofsight in adulthood. It affects about one in 5000 individuals world wide. Individuals whosuffer from RP lose vision because of the death of both rods and cones throughout the retina.Most forms of RP, and allied retinal diseases, are monogenic and have classical inheritancepatterns: autsomol dominant; autosomal recessive; and x-linked or mitochondrial (maternallyinherited), however, some families with RP exhibit more complex inheritance patterns. Ageof onset in the majority of cases is during the 20s which severely impacts individual’sactivities.

Incidence of RP can be reduced through genetic counselling. In the context of Pakistan, it isworthwhile to note that there is a non-governmental organization, the Pakistan FoundationFighting Blindness - a pioneering research organization, engaged in research on retinitispigmentosa in collaboration and cooperation with researchers and ophthalmologists of highnational and international repute. It is involved in collection of data on affected families since1995 and has database of more than 12000 visually impaired individuals (Research Paper,Presented by: Dr. Farhat Jabeen).

1.3.4. Autism Spectrum Disorder (ASDs) (a)

It is a complex developmental disability that causes problems with social interaction andcommunication. Symptoms usually start before age three and can cause delays or problems inmany different skills that develop from infancy to adulthood.

Different people with autism can have very different symptoms. Health care providers thinkof autism as a “spectrum” disorder, a group of disorders with similar features. One personmay have mild symptoms, while another may have serious symptoms, but both have anautism spectrum disorder. Currently, the autism spectrum disorder category includes:

• Autistic disorder (also called “classic” autism);• Asperger’s syndrome; and• Pervasive Development Disorder Not Otherwise Specified (or atypical

autism).

In some cases, health care providers use a broader term, pervasive developmental disorder todescribe autism; this category includes the autism spectrum disorders above, plus ChildhoodDisintegrative Disorder and Rett syndrome.

(a) http:// www.nichd.nih.gov/health/topics/asd.cfm

1.3.5 Speech Disorder (SD)

Speech disorders or speech impediments, as they are also called, are types of communicationdisorders where 'normal' speech is disrupted. This can include stuttering and lisps. Someonetotally unable to speak due to a speech disorder is considered mute.

In many cases the cause is unknown, however, there are various known causes of speechimpediments, such as "hearing loss, neurological disorders, brain injury, mental retardation,drug abuse, physical impairments such as cleft lip or palate, and vocal abuse or misuse. Childabuse may also be a cause in some cases.

Language disorders are usually considered distinct from speech disorders, even though theyare often used synonymously. Speech disorders refer to problems in producing the sounds ofspeech or with the quality of voice, where language disorders are usually an impairment ofeither understanding words or being able to use words and do not have to do with speechproduction.

1.3.6 Cerebral Palsy

Cerebral palsy (CP) is an umbrella term encompassing a group of non-progressive, non-contagious conditions that cause physical disability in human development. CP is caused bydamage to the motor control centers of the young developing brain and can occur duringpregnancy (about 75%), during child birth (about 5%) or after birth up to about age three(about 15%). CP is the second-most expensive developmental disability to manage over thecourse of a person's lifetime

Cerebral Palsy is divided into four major classifications to describe the different movementimpairments. These classifications reflect the area of the brain damaged. The four majorclassifications are:

• Spastic;• Athetoid / Dyskinetic;• Ataxic ; and• Mixed.

Despite years of debate, the cause of the majority of cases of CP is uncertain. Somecontributing causes of CP are asphyxia and hypoxia of the brain, birth trauma, prematurebirth, central nervous system infections and certain infections in the mother during andbefore birth. CP is also more common in multiple births.

1.3.7 Muscular Dystrophy(a)

Muscular dystrophy refers to a group of genetic, hereditary muscle diseases that causeprogressive muscle weakness. Muscular dystrophies are characterized by progressive skeletalmuscle weakness, defects in muscle proteins, and the death of muscle cells and tissue.

These conditions are inherited, and the different muscular dystrophies follow variousinheritance patterns. The best-known type, Duchenne muscular dystrophy (DMD), isinherited in an X-linked recessive pattern, meaning that the mutated gene that causes thedisorder is located on the X chromosome, one of the two sex chromosomes, and is thusconsidered sex-linked. In males (who have only one X chromosome), one altered copy of thegene in each cell is sufficient to cause the condition. In females (who have two Xchromosomes), a mutation must generally be present in both copies of the gene to cause thedisorder (relatively rare exceptions, manifesting carriers, do occur due to dosagecompensation/X-inactivation). Males are therefore affected by X-linked recessive disordersmuch more often than females. A characteristic of X-linked inheritance is that fathers cannotpass X-linked traits to their sons. In about two thirds of DMD cases, an affected male inheritsthe mutation from a mother who carries one altered copy of the DMD gene. The other onethird of cases probably results from new mutations in the gene. Females who carry one copyof a DMD mutation may have some signs and symptoms related to the condition (such asmuscle weakness and cramping), but these are typically milder than the signs and symptomsseen in affected males. Duchenne muscular dystrophy and Becker's muscular dystrophy arecaused by mutations of the gene for the dystrophin protein and lead to an overabundance ofthe enzyme creatine kinase. The dystrophin gene is the largest gene in humans.

1.3.8 Prenatal Environmental Causes

The prenatal environment is almost always a safe and nourishing one for a developing baby,but there are some environmental influences that can damage a foetus. These influencesinclude external agents, infections, toxins, and maternal health. External agents that cancause prenatal damage include injury and radiation. Any violent blow to the mother’sabdomen can also hurt her child. Radiation such as x-rays can affect the foetus. Someinfections the mother suffers can damage the infant when the disease organisms cross theplacental barrier. Rubella can cause severe disabilities, including blindness and mentalretardation. Syphilis and Acquired Immune Deficiency Syndrome (AIDS) can not only affectthe foetus in the uterus but also may infect the baby during birth. Many prescription and non-prescription drugs can cross the placenta and adversely affect the developing child. Drugssuch as heroin and cocaine can cause decreased central nervous system function andaddiction in the foetus. A wide range of prescription medications such as hormones,anticonvulsants, antibiotics, and tranquillizers are known to affect the baby in the womb.

Maternal health and nutrition affects the developing child. Deficiencies in iron, vitamins, andcalorie intake can place the baby at risk. Illness of the mother, especially long-term illness,can also affect the child. The age of the mother is another factor associated with an increased

(a) http:// www.nichd.nih.gov/health/topics/asd.cfm

risk of impairment. Teen-age mothers, especially those under 15 years of age, have a greaterrisk of having babies with low birth weight, which can be one of the causes of disability.Babies who are full term, but unusually small, are more likely to have a disability than arelarger, more robust infants.

1.3.9 Poverty related Causes

Poverty is the root cause of social problems including the deprivation of basic necessities likefood, clothing and shelter. It also leads to several social implications such as malnutrition, illhealth and illiteracy. Poverty has numerous facets, manifested in the form of low income,lack of access to resources, few opportunities for participation in political process and highvulnerability to risks and shocks. The main cause of rise in poverty in Pakistan lies in thewide spread structural inequality that leads to the exclusion of poor from both owning andaccessing assets and services. The main reasons of increase in poverty in urban areas havebeen unemployment and in rural areas is lack of assets.

In 2001, on the basis of Pakistan Household Integrated Economic Survey (HIES) data andusing adult equivalent requirements of 2350 calories per day, consumption-based absolutepoverty incidence (i.e. percentage of population below the poverty line) was estimated to be32.1%: 38.9 %in rural areas and 22.7% in urban areas as shown in table below:

Count 1992-93

HIES

1993-94

HIES

1996-97

HIES

1998-99

HIES

2000-01

HIES

Poverty Incidences: Head Count (Percentage)

Overall 26.8 28.7 29.8 30.6 32.1

Urban

Areas

28.3 26.9 22.6 20.9 22.7

Rural

Areas

24.6 25.4 33.1 34.7 39.0

Source: Planning Commission of Pakistan

It is often quoted in international reports that 20% of the poor in developing countries aredisabled. No empirical evidence with regard to socio-economic profile of the PWDs isavailable. The Poverty Assessment Surveys/Studies, however, reveal that one third of thePakistani population continues to live below the poverty line and there are alarming gaps insocial attainment even after six decades of development. The existing poverty prevalence ratecan safely be co-related to the population of PWDs that at least one third of the population ofpersons with disabilities live below the poverty line. Malnutrition, poor health facilities result

upon high infant mortality rate and an increase in the incidence of disabilities. There can beno denial that external environment like imbalance diet, poor housing conditions, lack ofaccess to clean drinking water and poor sanitation facilities have a direct bearing on humangrowth and development. Survey of services and facilities for the PWDs carried out by theDGSE in 2006 clearly indicates a wide gap in students’ enrolment. It was astonishing to notethat only 4% of children with disabilities utilize educational facilities. The conditions inemployment sectors are in no way different.

The socio-economic profile of the PWDs of our neighbouring country (India) contained inthe World Bank document-2007 confirms the hypothesis that disability rates tend to rise withcountry’s income level. It shows substantially higher rates of illiteracy among PWDspopulation. The share of disabled children who are out of school is dramatically higher thanother social categories with average out-of-school rate for children with disabilities (CWD)five and half times the rate of all children and approximately four times even that ofscheduled casts and tribe population (generally considered to have poor educationaloutcomes). Similarly PWDs participation in labour market and employment is also lowcompared to general population owing to the discrimination and stigma.5

1.3.10 Perinatal Causes:6

The perinatal period is the time immediately before and after birth. Disabilities originating fromthis time period are primarily biomedical ones. They may result from pre-maturity of the foetus,injury, oxygen deprivation, or infections acquired during the movement through the birth canal.Premature infants are babies who were born pre term i.e. too soon. They are more likely to havecongenital disabilities than any other infant. They are at risk because of their immature bodilydevelopment and lack of preparation to survive independently. Many premature infants requirethe supplemental use of oxygen and some suffer a form of blindness called retinopathy caused byan excess of the very oxygen that preserved their lives (World Health Organization, 1992).Oxygen deprivation may occur during a prolonged or difficult birth because the brain suffersdamage very quickly without a fresh and adequate supply of oxygen, brain damage can result.The effects of this damage may include impairments in the areas of motor control, intelligence,and sensory processing. The severity of the impairment reflects the severity of the damage doneto the baby’s brain. Sexually transmitted diseases (STD) can be contracted during vaginaldelivery. These infections include syphilis, AIDS, gonorrhoea and herpes. Gonorrhoea affects theeyes of the infant, but herpes can result in severe disabilities due to nervous system damage.AIDS can also infect a baby through breast-feeding.

1.3.11 Causes in Childhood:7

Disabilities originating during childhood may be caused by biomedical and environmentalfactors including the following:

Childhood Injuries: The causes and circumstances of childhood injuries show a distinctpattern in different age groups. For the new born and infants the most common risk situation

5 People with Disabilities in India; From Commitments to Outcomes, The World Bank-20076 Situation Analysis, M/S Arjumand Associates, 20047 Situation Analysis, M/S Arjumand Associates, 2004

involves falling from bed or from parents, siblings’ or grand parents’ arms. It is difficult foryoung parents to imagine all the dangers to which an infant may be exposed especially if it istheir first child and they have no experience of child care. In Pakistan, with exception ofeducated and affluent social classes, access to child-care training for pregnant women isnon-existent. When children begin to walk, their movements are not fully coordinated. Anactive child knocks into the corners of furniture, falls over articles of furniture onto whichthey climb to obtain something from shelf or cupboard. Heavy objects sometimes fall onchildren when they try to take them off high shelves. Children often hurt their fingers whileclosing doors and drawers. Of paediatric causalities, a large proportion of injuries involvebruises, broken bones, and burns from hot objects like stoves or hot teapots when childrenreach out to help themselves.

Children also injure themselves with broken glass, knives, and razor-blades. Children playwith small objects such as buttons, safety pins and put them into body orifices, the result ofwhich they may come to casualty with foreign bodies in the alimentary canal, the ear or thenose. Children like to run, jump, investigate things and places, drag things around and turntaps and switches on and off. They imitate older siblings, parents, and domestic workers andget into dangerous situations if not constantly watched. Preschool and primary school agechildren sustain nearly 1/4th of all childhood injuries. The resultant injuries can producemotor or intellectual impairments as well as temporary damage such as bruises and brokenlimbs. Sometimes, they choke on small objects such as tiny toys, or pieces of toys. This typeof accident can result in suffocation, anoxia, and brain damage. Many of these accidentsresult in disabilities. Spinal cord and brain injuries are of special concern due to the seriousconsequences of damage to the central nervous system. Injuries often occur as a result ofinadequate protection when children are riding in motor vehicles or as passengers onmotorcycles and bicycles.

Childhood Diseases: Disabling conditions can sometimes result from common infectiousdiseases. Childhood diseases can retard a victim’s future development. One of the severecauses of disability is meningitis suffered by the child in early infancy, leading to sensory,motor and intellectual limitations. Encephalitis, an inflammation of the brain that can causemental retardation, is a possible complication of such childhood illnesses as mumps, chickenpox, and measles. Measles sometimes cause visual impairment. Ear infections that oftenaccompany children’s colds can result in conductive hearing loss. Deafness can be genetic, itcan be caused by illnesses such as mumps, measles, meningitis or rubella (either duringpregnancy or in childhood) Deafness can be caused by repeated exposure to loud noise suchas loud music, loud machinery or explosions.

1.3.12 Environmental and Socio Economic Causes

Environmental factors whether economic, social, cultural or physical intensify the effects ofbiological impairments and increase the likelihood of disability. Environmental deprivationhas a debilitating effect on the development of abilities such as language use, and adaptivebehaviour. Cognitive deprivation includes poor nutrition, poor housing, lack of socialinteraction and limited exposure to varied experiences. These conditions are often associatedwith poverty but can occur in any environment. They may be the outcome of neglect or

abuse. Poor nutrition and starvation have proved to be retarding factors for the child’sdevelopment. Hunger produces nervousness, irritability and decreased ability to learn. Severedeficiency of vitamin “A” can cause blindness in children after they are weaned (WorldHealth Organization, 1992). A protein-calorie deficit during first six months of life affectsthe mental development. Economic hardships due to lack of employment opportunities andlow family income can lead to late or limited schooling, which can result in intellectualimpairments and functional limitations.

1.3.13 Causes in Adolescence

Adolescence or teen age years are labelled as an age of storm and stress. Adolescents becomevulnerable to injuries when they perform dangerous acts of bravado. They are often involved inhigh risk physical activities because of their active life style. The most common causes of theinjuries sustained include falls from motorcycles, motor car accidents and physical violence.Juvenile delinquency occurs relatively often among youth coming from broken families with ahistory of criminal acts or mental disorders. Drug addiction among youth is another menace ofthe present day. Drugs have become more varied including use of natural drugs, such as cocaine,opium, and manufactured drugs such as heroin, and a wide range of sedatives and tranquilizersreadily available in the market.

1.3.14 Causes in Old Age

As the people grow older the chances of disabilities increase due to degenerativechanges/conditions which impact the individual’s quality of life such as limitation ofmobility and agility. Chronic health conditions include rheumatism and arthritics. Strokesmay cause brain damage that affects language skills and mental ability or physical activity.Poor coordination may result in falls and other accidents. The elderly also encounterproblems because of mental health conditions, senility, dementia, deafness, blindness, feelingof loneliness and boredom.

______________________________________________________________________________________Situation Analysis and Plan of Action 2004 proposed by Arjumand Associates

SECTION 2: MAGNITUDE OF THE PROBLEM IN PAKISTAN

The creation of the United Nations Disability Statistics Data Base (DISTAT) in 1988spearheaded an important attempt to identify and compile the world’s existing disabilitystatistics. Most of DISTAT statistics were collected using the original InternationalClassification of Impairments, Disabilities, and Handicaps (ICIDH) classification system,thus eliminating some of the definition problems that had previously hampered comparisonof international data sets. DISTAT has grown to contain disability statistics from 177national studies from 102 countries. The data sets are formatted by the United NationalStatistical Office (UNSO) for electronic dissemination. The estimates of disabled populationof 175 countries show the proportion of people with disabilities in High HumanDevelopment (HHD), Medium Human Development (MHD) and Low Human Development(LHD) countries to be 9.9%, 3.7% and 1.0% respectively. The total global disabledpopulation is estimated to be between 235.39 and 549.18 million; of HHD countries 124.23million; the range for the MHD countries estimated to be between 93.52–250.22 million forthe LHD countries the estimates are in the range of 17.65–174.74 million.

The prevalence of disabilities in South Asian countries appears in percentages below:

Instrument Bangladesh India Pakistan Sri LankaCensus/HH Survey 1.6 2.2 2.5 1.6Special Survey 13.3 6.8 - 4.0

Source: www.apedproject.org/country/profile/sri%lanka/srilanka.hotmail

In Pakistan, despite evidence of inclusion of disability in national censuses, the statistics ondisabilities suffer from inadequacies such as lack of standardized definitions, inconsistenciesin the inter-census data sets and their consequent incompatibility for national andinternational comparisons. Data sets on the disabled have been collected in the nationalpopulation census of 1961, 1973 and 1981. During the period 1984-1985, the Federal Bureauof Statistics (FBS) conducted a national survey to fill this data gap. A national sample of5,638 households was surveyed to assess the incidence of disabilities. Unfortunately, thecategories and definitions of disability were not consistent with those of the 1981 census,thus making it impossible to compare disability-specific rates. In 1986, another survey wasconducted in Islamabad and Rawalpindi by the Directorate General of Special Education(DGSE) which revealed a remarkable decrease in incidence of disability i.e. 2.5 whencompared to WHO’s estimates of 10 percent of the total population.

Inconsistencies in data sets on disability are apparent in Table 2.1. Does the data meananything? The wide variations in data would make one question the credibility. In view of theunreliability of these data, what basis do the disability programme planners have? On thewhole, data on the disabled population in Pakistan present a number of problems includingthose of definitions, reference periods, inconsistent categories, heavy dependence on therespondent’s self-reporting that obscures objectivity and makes enumeration of disabilitiesdifficult. The demography of disability is difficult. Counting persons with disabilities is farmore challenging than is counting males. That is because disability is not just a statuscondition, entirely contained within the individual. Rather, it is an interaction betweenmedical status (eg having low vision or being blind) and the environment

TABLE 2.1

ESTIMATES OF DISABILITY (1961-81) PAKISTAN

1961 1973 1981

Total Population 42, 880, 378 60,509,535 84,253,644

Total Number ofPWDs

135,668 1,257,454 371,420

Percentage of totalpopulation

0.31 2.07 0.44

Source: Asia-Pacific Population Journal Vol. 10, No.1, March 1995

2.1 National Profile

The Pakistan Census Organization (PCO) in its 1998 national census estimated the extent ofdisability under seven categories: Crippled; Insane; Mentally Retarded; Multiple Disability,Blind; Deaf & Mute and Others. As reflected in Graph-1, the total number of PWDs wasfound to be 3,293,155 against the total population of 132,352,279 giving an overallpercentage of 2.49.

Graph-1

Population of Disabled Persons (National)

DisabledPopulation,3,293,155

Total Population,132,352,279

Source: National Population Census of Pakistan, 1998

Graph-2 presents percentage of the disabled population by category showing: Crippled(19%); Insane (6%); Mentally Retarded (8%); Multiple Disability (8%), Blind (8%); Deaf &Mute (7%) and Others (44%).

Graph – 2

0

5

10

15

20

25

30

35

40

45

VisuallyHandicap

PhysicallyHandicapped

MentallyHandicapped

Others

Percentage of Disabled Persons in Pakistan by category

Source: Disabled Population of Pakistan, PIDE/Dr. Razzaque Rukanuddin, July 2003.

The Pakistan Institute of Development Economics (PIDE) in 2003, in it’s in depth analysis of1998 national census data on disability noted various inadequacies and inconsistencies.According to the PIDE analysis, variations in the prevalence of disability were presumablydue to misreporting; under-reporting or hesitation on the part of respondents to disclosefactual information on PWDs (possible interview bias). Moreover there are concerns aboutthe likelihood of enumeration and instrument bias i.e. only severely disabled wereenumerated (re: item 31 of PCO 1998 Survey Form) that led to under-reporting of overallprevalence of disabilities and handicaps. In absolute terms the 1998 census recorded 3.29million PWDs out of a total population of 132.35 million. Of these 1.89 million were maleand 1.40 million. The disability prevalence rate was higher for male than female in rural vis-à-vis urban areas (Graph 3).


2.2 Province Wise Disability Prevalence

The population of persons with disabilities by province is reflected in the graph blow:

Graph – 4Number of Persons with Disabilities by Province


Graph-4 above reveals that the highest number of the persons with diabilities in Punjab (1,826,623), followed by Sindh (929,400), North West Frontier Province (NWFP) (375,448)and Balochistan (146,421).

Graph-3

Disabled Population (in millins) by Gender & Urban /RuralResidence - Pakistan

1998

TotalRuralUrban

3.5

3

2.5

2

1.5

1

0.5

0

Male Female Total

Though the sheer number of PWDs in each province may appear to be in proportion and inthe same order as the total population of each of these provinces, when seen in terms of thenumber of PWDs out of every hundred [or 100,000 which is what most rates are calculatedfrom] in a province, the province of Sindh has the highest percentage of PWDs followed bythe AJK (3.06 and 2.7 % respectively). However while presuming that mental stresses of thekind people may suffer in a cosmopolitan city like Karachi in the province of Sindh, contraryto ones expectations it is the province of Punjab where the number of mentally handicappedPWDs turns out to be quite a number of times higher than the other kinds of disabilitieswithin the same province (Graph 6).

Pun

jab,

2.4

8

Sin

dh, 3

.05

NW

FP, 2

.12

Bal

ochi

stan

, 2.2

3

FAN

A, 2

.46

AJK

, 2.7

Disabled Population as % of The Total Population of Each Area

Source: National Population Census of Pakistan 1998.

Graph - 5

Not surprisingly the percentage of those whose disability could not be clearly identifiedbecause of either the lack of proper diagnostic evidence made available to the enumerator ordue to the poor reporting, the percentage of those classified as ‘others’ is the highest in all theprovinces. The second highest category is that of physically handicapped persons, which, asper province comparison, turns out to be the highest in the province of NWFP, obviously dueto the aftermath of the Afghan war and the presence of large number of refugees having fledfrom the troubled areas. The third highest category is of visually handicapped persons almostin all the provinces though not with much of a difference in provincial percentage of suchpersons. Demographically it may reflect not only somewhat uniform percentage of olderpeople in provincial populations but also the highly identifiable nature of disability i.e. usingeye glasses, white canes or someone’s support while walking.

Disability Wise Disabled Population Compared (%)

0

5

10

15

20

25

30

35

40

45

50

55

60

Punjab Sindh NWFP Balochistan FANA AJK

Visually Handicapped Hearing Impaired Physically Handicapped

Insanity Mentally Handicapped More Than One Disability

Others


Graph - 6

Graph -7

V i sual l y Handi capped, 8. 48

Hear i ng I mpai r ed, 8.17

Physi cal l y Handi capped, 20.83

Insani ty , 6 .75

M ental l y Handi capped, 7. 87

M or e T han O ne Di sabi l i t y, 8 .07

Other s, 39. 83


2.3 Disability Prevalence In Punjab

The analysis of the various categories of PWDs reveals that the largest percentage (39.83%)fall in the category “Others”. Physically handicapped constitute the next highest percentageof 20.83%. The other categories include visually handicapped (8.48%), hearing impaired(8.17%), insane (6.75%), mentally handicapped (7.87%) and more than one disability (8.07%of the total persons with disabilities).

Percentage of the Total Disabled Population by Category

2.4 Disability Prevelence In Sindh

A majority of the PWDs fall in the “Other” category (53.28%) whereas physically handicapped constitute10.56%. The other categories range from insane (6.13%), hearing impaired (6.18%), mentally retarded(7.45%), visually handicapped (7.48%) and persons with multiple handicaps (8.92%).


Percentage of Total Disabled Population by Category

Visually Handicapped, 7.48

Hearing Impaired, 6.18

Physically Handicapped, 10.56

Insanity, 6.13

Mentally Handicapped, 7.45

More Than One Disability, 8.92

Others, 53.28

Graph-8

2.5 Disability Prevalence in NWFP

majority (31.92%) of the disabled population fall in the category of “Others”, whereas physicallyhandicapped are 31.70%, which most probably reflects the effects of Afghan War that resulted in heavycasualties and large number of amputees at the Pak-Afghan boarder area. The other disabilities vary frominsane (5.90%), visually handicapped (7.24%), mentally handicapped (7.44%), hearing impaired (7.69%)and multiple disabled (8.11%).





Insanity, 5.9Mentally Handicapped,

7.44


Others, 31.92


Graph-9

The

2.6 Disability Prevelence In Balochistan

A little more than half of the total disabled population (54.97%) belongs to the “Others” category. Thephysically handicapped rank the next highest (14.81%) while the other categories range from insane(4.60%), hearing impaired (5.24%), mentally handicapped (5.61%), multiple handicapped (6.35%) andvisually handicapped (8.42%).


Graph-10





Insanity, 4.6



Others, 54.97

2.7 Disability Prevelence in Frontier and Northern Areas (FANA)

A little more than one third of the total disabled population (37.73%) belongs to the “Others” category,where as physically handicapped and hearing impaired were found to be 21.67% and 16.18 respectively.The other categories range from mentally handicapped (4.69%), insane (4.97%), multiple handicapped(6.24%) and visually handicapped (8.52%).




Insanity, 4.97

Others, 37.73





Graph - 11

2.8 Disability Prevelence in Azad & Jammu Kashmir (AJK)

A little less than one third (31.95%) belong to “Others” while about one fourth (23.46%) fall in thecategory of physically handicapped. The other categories range from insane (7.12%), mentallyhandicapped (8.17%), visually handicapped (8.88%), multiple handicapped (10.17%) and hearingimpaired (10.25%) of the population with disabilities.




Insanity, 7.12

Others, 31.95





Graph-12

SECTION 3: DEVELOPMENT OF SPECIAL EDUCATIONPROGRAMMES IN PAKISTAN

3.1 Evolution Of Disability Programme

There is evidence of historical developments that underpin educational provisions for thedisabled in Pakistan. The earliest formal disability rehabilitation center were agovernment blind school at Lahore, opened in 1906, and the Ida Rieu School for blind,deaf, dumb and other handicapped children at Karachi in 1923. Pressure from parents ofdeaf children in the late 1940s resulted in the formation of a “Deaf and Dumb WelfareSociety” at Lahore in 1949, and a special school opened afterwards. Soon afterindependence in 1947, a more extensive integration of children with visual impairmentsbegan in a middle school at Pasrur. However, children with various impairments anddisabilities continued to be part of the normal enrolment throughout primary and evensecondary school classes.

Studies and reports confirm that children with appreciable levels of learning difficultycontinued to sit in regular classrooms without being paid any special attention. TheCommission on National Education Pakistan, 1960 recommended that government beresponsible for training of teachers to serve in institutions for the handicapped run byprivate philanthropists. It was not until the early 1980s that the Government of Pakistan(GoP) began more serious contemplation of provision of educational opportunities todisabled children.

Observance of the International Year of Disabled Persons (IYDP), 1981 followed by theDecade of the PWDs (1983-92) created awareness among masses, including thegovernment sector, about the care, welfare, education, training and rehabilitation ofpersons with disabilities in Pakistan. As a follow up of IYDP, an infrastructure in theform of the Directorate General of Special Education (DGSE) was created in 1985 atfederal level. Under the aegis of DGSE a number of special education institutions weresetup at federal, provincial, divisional and district headquarters. It provided financial andtechnical assistance to the provincial governments and NGOs to establish programmesfor persons with disabilities in their own domains.

Pursuant to our national and international commitments, all Pakistani children have aright to education, whether able-bodied and able-minded or not. In practice, half ofPakistan’s children begin primary education, and half of these children drop out beforecompleting the cycle. Among the dropouts, girls and children with disabilities aredisproportionately represented. Data from government sources suggest a growth ofeducation services for children with disabilities over time as shown in graph 13:

3.2 Institutional Arrangements

The State has an Education For All (EFA) policy that assures all children, includinghandicapped children, have the right to a free appropriate public education. There is,however, no established time specific goal for providing full educational opportunity toall handicapped children and a detailed road map for accomplishing such goals at alllevels viz. union council, tehsil and district. Moreover, provincial operational plansdescribing the type and number of facilities, personnel, and services required to makepossible delivery of services for disabled are currently lacking. Under the DGSE-ledinstitutional arrangements, there is no monitoring mechanism in place to keep liaisonwith provincial, district, tehsil and union council levels both in public and NGO sectors.

Currently, each Provincial Government has individualized special education programmes.In the provinces, DGSE’s rules and procedures do not apply in public or privateinstitutions or other care facilities that are not functioning under its administration. Thedevolved district governments are responsible for all educational programs includingthose of handicapped children and training of their teachers. Prior to the devolution ofpower plan 2001, at the provincial level the Social Welfare Departments (SWD) weregenerally responsible for assuring the requirements of Special Education (SE) includingmaintaining liaison with all such programmes administered by NGOs and the privatesector. In Punjab, however, an independent Special Education Department (SED) wasestablished in 2003 and is responsible for educational programmes for persons withdisabilities. The Government of Punjab has established a goal of providing fulleducational opportunities to all handicapped children through a comprehensive system ofpersonnel development mandated and established under the elected provincialgovernment. The Punjab Government has established a detailed timetable foraccomplishing this goal and a plan of action providing a description of the kind and

0

200

400

600

1947 1960 1970 1980 1990 200 2006

Special Schools in Pakistan (1947 - 2006)

Source: Survey of Services and facilities for persons with disabilities 2006 (DGSE)

Graph-13

number of facilities, personnel, and services necessary to meet the goal. The electedgovernment provides satisfactory assurance as regards provision of funds.

In 1985, the Directorate General of Special Education (DGSE) formulated a draftNational Policy for Special Education and revised it in 1988 to bring it in line with theemerging needs of target population. In 2002 a new National Policy for Persons withDisabilities was launched under the Ministry of Women Development, Special Educationand Social Welfare. Currently, the DGSE is under the Ministry of Social Welfare andSpecial Education and is carrying out the following functions:

to formulate and coordinate National Policy for Persons with Disabilities (PWDs);to organize census of PWDs;to establish Special Education (SE) centers all over the country;to provide manpower training; to provide medical and para-medical support toPWDs;to provide special aids and equipment for the use of PWDs;to create and provide job opportunities;to provide vocational training and to provide legislative support for PWDs.

Pakistan has been supportive of all International Treaties and Resolutions, which ensurethe protection and promotion of human rights including the rights of persons withdisabilities. Pakistan fully supports the recommendations of International Convention onDisability (Bangkok June, 2003) and the recommendations that were formulated inresponse to the invitation by the UN General Assembly in Resolution 57/229. Theequality and non-discrimination with reference to persons with disabilities is consideredimportant, as are the specific rights of persons with disabilities as spelled out in BangkokConvention. In addition, for the monitoring mechanisms proposed in the Bangkokrecommendations, Pakistan considers a need for a very strong media group, consisting ofinternational and regional representatives to highlight the violations, if any are committedby the member states

The DGSE assures that all handicapped children have available to them, within the timeperiod, free public education which emphasizes special education and related servicesdesigned to meet their unique needs., It assures that the rights of handicapped children areprotected, assists provinces to provide for the education of all handicapped childrentherein and to assess and assures the effectiveness of efforts to educate handicappedchildren. The term ‘free appropriate public education’ means special education andrelated services are being provided at public expense. The average per pupil expenditurein the public sector for handicapped children aged 5 to 14 inclusive receiving specialeducation and related services; is 10 times more than regular public elementary andsecondary schools in the country.

It is encouraging to observe that most of the DGSE’s appointed Directors/Principals ofFederal Special Education Schools in the provinces are in touch with the mainstreamprovincial programmes/projects. The provincial departments and the recently devolved

(Excerpts from Pakistan Country Paper, Bangkok 2003, Muhammad Majid

Qureshi, Director, Special Education/GoP)

local government organizations and their functionaries have limited knowledge withrespect to the federal policy and programmes and the emerging trends such as currentthinking to integrate the free public education of all handicapped children through themainstream educational system. Integrated education is the most recent approach adoptedin the developed world for the mainstreaming of the PWDs. The purpose is both tominimize expense and help the PWDs adjust in mainstream social environments. TheGovernment of Pakistan in its Perspective Development Plan 2001-11 (PlanningCommission of Pakistan, September 2001) spells out the need for integrated education ofPWDs in regular schools in all provinces. The plan states that all government schoolswould provide training of regular school teachers in Special Education andcomplimentary teaching aids and equipment for implementation of integration plan.Further an administrative mechanism at state level would be put on place to achieve thegoals of integration during the plan period extending between 2001 and 2011.

3.3 National Institutions

A variety of national institutions are functioning at the federal capital, Islamabad, underthe supervision of Directorate General of Special Education. Brief functions of eachinstitution are summarized below:

a) National Institute of Special Education (NISE): established in 1986 developscurriculum and conducts training of SE teachers in all four currently served disciplines:VH, HI, PH and MR. Twenty to twenty-two training programmes are conducted on anaverage every year.

b) National Council for Rehabilitation of Disabled Persons (NCRDP): founded in1982 to implement and monitor the affirmative action plan for the rehabilitation andemployment of disabled under 1981 ordinance for provision of 1% employment quota tothe disabled. The NCRDP has a Board of Governors (BOG) represented by both publicand NGO sector leadership in disability.

c) National Mobility and Independence Training Centre (NMITC) for visuallyhandicapped (VH): conducts courses on mobility and independence of VH.

d) National Training Center for Special Persons (NTCSP): established in 1986 withthe prime objective to provide vocational rehabilitation to persons falling under VH, HI,MR and PH categories, an average 100 students are taken on l annually to impart skills intailoring, typing, short hand, welding, electrical work, carpentry and a variety of otherskills. Employability of trained individuals is a major problem.

e) National Special Education Centers: provide services such as assessment anddiagnostics, education up to Primary, Middle, Secondary and Higher Secondarylevels, pre vocational and vocational training, early intervention , physiotherapy,speech therapy , occupational therapy, indoor and outdoor recreation facilities andparents’ counselling.

f) National Library & Resource Center (NLRC): established in 1986 serves as aresource center for print and audio-visual material on special education and disabilities.About 10,000 reference books are currently available. I Internet facilities are alsoavailable for professionals and researchers.

g) National Institute for Handicapped (NIH): established in 1987 as speech andhearing disorder therapy center and subsequently upgraded to a general hospital forhandicapped in 1997. It has physiotherapy, orthopaedic, surgical, ENT, pathology andradiology departments serving both disabled and non-disabled patients. It has now beentransferred to Ministry of Health because of its clinical nature. Recently, NIH has beenrenamed as National Institute for Rehabilitation Medicine with a view to achieve broadbased goals.

h) National Trust for the Disabled (NTD): established in 1988 under the CharitableEndowment Act, 1890 to ensure implementation and coordination of the services fordiagnosis, assessment, treatment, education, job placement and rehabilitation of PWDs.NTD is an autonomous body under the administrative control of the Ministry of SocialWelfare & Special Education. It has a Board of Governors (BOG) comprising seniorgovernment officials and NGO representatives in the field of disability. Currently NTD isindependently running 3 SE schools, two in Sindh and one in Punjab.

i) Vocational Rehabilitation and Employment of Disabled Persons (VREDP:established in 1993 with the objective of promoting community based rehabilitation(CBR) through skills training and micro credit facilities in collaboration with LahoreChamber of Commerce an affiliate group named as Lahore Association of Businessmenfor Rehabilitation of Disabled (LABAD).

3.4 Disability Wise Special Education Schools / Institutions

The data collected by the DGSE in 2006 reveals that there are 531 special educationinstitutions in the country catering to the education and training needs of the persons withdisabilities as reflected in Graph-14:

It is evident from the above graph that more than half of the total institutions (276) arecatering to the needs of persons with more than one disability, 95 for hearing impairedchildren, 54 for visually impaired children, 43 for mentally retarded, 40 for physicallyhandicapped and 23 for multiple handicapped.

3.5 Region Wise Distribution Of Institutions

The region/area wise distribution of the institutions is reflected in the graph below:

0

50

100

150

200

250

300

More ThanOne Disability

HearingImpaired

VisuallyHandicapped

MentallyRetarded

PhysicallyHandicapped

MultipleCases

Disabilty Wise Distribution of Special Education Institutions

Source: Survey of Services and Facilities for Persons with Disabilities, DGSE-2006

Area/ Region Wise Distribution of Institutions (%)

Punjab, 51.4

AJK, 1.9

Balochistan, 2.3

Capital Area, 6.4Northern Areas,

2.6

NWFP, 13.2

Sindh, 22.2


Graph - 14

Graph - 15

The Punjab province ranks highest with regard to the establishment of specialeducation institutions. More than half of all institutions (51.4%) exist in Punjab,22.2% in Sindh, 13.2% in NWFP and 6.4% at the capital. The number ofinstitutions in Balochistan, Northern Areas and AJK ranges from 1.9% to 2.6%.

3.6 Level And Nature Of Special Education InstitutionS

Graph 16 below indicates that 34.46% (183) schools are of primary level, 69(12.99%) middle, 56 (10.54%) high and 8 (1.53%)institutions of degree and postgraduate level. 53 institutions ( 9.98%) provide training in basic skills. Thenumber of vocational training centers comes to 26 (4.89%) and 136 centers(25.61%) provide other services.


3.7 Administrative Control Of Special Education Institutions

The institutions for persons with disabilities function under the administrativecontrol of various organizations such as federal government, provincialgovernment, district/city government, individuals and NGOs. The breakdown ofthese institutions is reflected in the graph-17:

0

20

40

60

80

100

120

140

160

180

200

BasicSkills

Middle Degree Vocational

Special Education Schools/Institutions in Pakistan and Nature of Education / Training Imparted

Graph - 16

Administrative Control of Institutions (%)

District Gov., 25.61

Semi Gov., 2.25

Provincial Gov., 11.86

NGOs, 34.65

Individuals, 10.54

International Organizations, 2.48

Federal Gov., 12.61


0

50

100

150

200

250

300

Rented Self Ow ned

Rented and Self-owned Status of Buildings of Institutions


Graph - 17

Graph - 18

The above graph reveals that more than a third of the institutions (34.65%) areunder the administrative control of the NGOs, more than one quarter (25.61%) areunder the administrative control of district governments. The share of federal andprovincial governments in the administrative control comes to 12.61% and11.86%. 10.4% of institutions are under the administrative control of individuals,2.5% under the administrative control of semi-government and 2.48% under thesupervision of international organizations.

3.8 Rented And Self-Owned Buildings

The study of the institutions reveals that 300 institutions (56.5%) are located inrented buildings whereas 231 institutions (43.5%) are in self-owned buildings.

3.9 Accessibility In Special Education Institutions

As reflected in graph below 79.5% of the buildings have barrier free accesswhereas 20.5% have restricted access facilities.

Level of Access (%)

-Source: Survey of Services and Facilities for Persons with Disabilities, DGSE 2006

3.10 Student Enrolment

Graph 20 indicates that about two-thirds (17,813) of the total students enrolled inthe special education centers are male whereas a little more than one-third(10,417) are female. This reflects the gender disparity which can be attributed tosocio-cultural condition of the country.


Barrier FreeAccess, 79.5

RestrictedAccess, 20.5

Graph - 19

Graph - 20

1800016000140001200010000

8000600040002000

0

Boys Girls

Gender Wise Enrollment in Special EducationInstitutions

3.11 Special Education Teachrs

In order to address the educational needs of CWDs, the Government and NGOsrely upon teachers who have been trained in the specialized field of specialeducation. In the lives of children and youth with disabilities and in their long-term achievements in learning, special education teachers play a vital andindispensable role. National Institute of Special Education (NISE) encouragesthose interested in becoming special educators and gives them an opportunity toattend courses of different duration about special education.

In the early days of the special education system in Pakistan, teachers wereemployed or assigned to teach in a field in which they were not academicallycertified. The situation has now improved considerably with the establishmentand expansion of education and training facilities available in Allama Iqbal OpenUniversity (AIOU) Islamabad, Punjab University Special Education DepartmentLahore, Karachi University Special Education Department and Teachers TrainingColleges established by the Special Education Department of the PunjabGovernment at Lahore and National Institute of Special Education, Governmentof Pakistan at Islamabad. The special incentives like double pay for trainedSpecial Education Teachers have been instrumental in promoting and up-gradingof the qualifications of teachers but on the other hand this has also deprivedseveral NGOs of trained teachers who prefer to join jobs with better pay. Thenumber of Special Education Teachers has increased over the time. The datareflected in Graph 21 indicate that there are 2,992 teachers employed in schools,the gender of these teaching staff comes to 70% male and 30% female.


0

500

1000

1500

2000

2500

3000

Male Teachers Female Teachers Total # of Teachers

Number of Male and Female Teachers

Graph - 21

3.12 Teacher Qualification And Training

The level of teacher training remains below the desired standard. Out of the totalteachers (2,992), there are 529 teachers who possess Master’s Degrees in SpecialEducation, 408 teachers possess M.A/M.Sc. in other subjects with PTC / CT /B.Ed. / M.Ed., 258 teachers have B.A / B.Sc. un-trained, 190 Matriculation un-trained, while 117 have PTC / CT and there are 499 teachers whose qualificationsare not given or reported. The percentage of teachers by qualification is reflectedin Graph-22 below:

Graph-22 shows that 17.7% of total teachers possess M.A. Special EducationDegree. A total of 16.7% did not report their qualifications, B.A. / B.Sc trainedteachers come to 14.4% , while B.A. / B.Sc. un-trained teachers were reported tobe 8.6%, with Matriculation trained 4.6%, Matriculation un-trained 6.4% , F.A.trained 4.2% and F.A. / F.Sc. un-trained 5%.

3.13 Vocational Training and Rehabilitation

The number of vocational training facilities for PWDs seems to have remainedstagnant. While science and modern technology have made tremendous leaps inthe latter half of the 20th century opening up new avenues and new horizons forthe able-bodied, the disabled are still being trained in traditional crafts and forsimple repetitive jobs like basketry, chair-caning, handloom weaving, packing,assembling, light electrical/mechanical works etc. Sadly, the opportunities foremployment even in these limited fields are dwindling rapidly. Agencies andinstitutions for the disabled find it easier to continue to operate on traditionalapproaches.

Qualification Wise Distribution of Teaching Staff (%)

BA/B.Sc, PTC/CT/B.Ed/M.Ed,

14.4

BA/B.Sc, Trained, 2.1

MA/M.Sc Untrained, 4

FA/F.Sc/TD, 0.7

Matric, PTC, CT, 3.9

Matric , TD, 0.7Matric Untrained, 6.4

MA/M.Sc,PTC/CT/B.Ed/ M.Ed, 13.6

MA/M.Sc,TD, 1.9

MA (Sp.Ed), 17.7

Not Reported, 16.7

FA/F.Sc PTC/CT, 4.2

BA/B.Sc, Untrained, 8.6

FA/F.Sc, Untrained, 5


Graph - 22

The number of these facilities is too meagre to meet the growing needs of thedisabled population. These services are available only in big cities like Karachi,Lahore and Islamabad depriving the major portion of persons with disabilitiesliving in the urban, sub-urban and rural areas of the country.

3.14 Community Based Rehabilitation

Most available vocational rehabilitation (VR) programmes tend to be centralizedin urban areas and delivered through static vocational training institutions. Theyare located usually in the capital or other large cities. The number of theinstitutions is very small. It is estimated that today, among the PWDs in need ofrehabilitation, only a small proportion have access to any vocational rehabilitation(VR) services. Moreover, most institutions provide rehabilitation only for certaintypes of PWDs and for certain age groups. The problem is serious for theestimated 70% of disabled population that live in rural areas. According to WHOestimate, 70 % of persons with disabilities in community need only simpletraining which could be provided by the family, with guidance from community-based rehabilitation workers. It is said that only 10 per cent of PWDs need thespecialized services provided by rehabilitation institutions.

Efforts to increase the accessibility of services in a community setting are beingpursued through community based rehabilitation (CBR) programmes both in thepublic and NGO sectors. Some of CBR programs are complimented with micro-credit programs. Social limitations caused by discrimination have reportedlydecreased as people are becoming accustomed to business interactions withpeople with disabilities. Many individuals who have never worked before, or havenever worked successfully, are able to function well in competitive employmentwith assistance provided by CBR training institutions.

In historical perspective, South Asia has a long heritage of informal and semi-formal responses by communities and individuals to disability from antiquity tothe present. Documented histories of the Indian sub-continent provide evidencethat disabled people played various roles in their families and communities,sometimes with a good deal of independence. Yet some evidence challengesstereotypes and suggests that disability historically evoked a wiser range ofresponses and initiatives. The practices and motivations of philanthropists, and theworthiness or unworthiness of recipients, were subjected to critical discussion inHindu, Jain, Buddhist and Muslim histories. Formal community-basedrehabilitation development in the 21st century could become more appropriate andeffective by studying the previous decades of cultural experience. While manypossibilities exist for enlisting local human resources in developing South Asiansocieties in which disabled people can live better lives, the most durable solutionsare likely to have long roots in the cultures and perceptions of the people and theircommunal histories.

Villages are the focal points of CBR programmes of the Association for theRehabilitation of the Physically Disabled (ARPD), NWFP Pakistan. The bulk ofthe rural population here is engaged in agriculture, rural trades, indigenous crafts,farming, including animal husbandry. Rural families are normally large; three orfour generations live and work together to survive in a labour-intensive agro-based economy. The CBR approach envisages a similar partnership betweenPWDs and the rest of the community for its socio-economic development. ARDPhas established a network system in the community among PWDs, support serviceproviders and policy makers at the provincial and national levels. Presently ARDPhas established 61 CBR centres by networking with 300 partner organizations in100 towns of the country . The concept of the rights and duties of PWDs toparticipate individually and collectively in the planning and implementation ofservices is exemplified in this community-based approach.

One CBR group in the public sector in Pakistan is the Islamabad-basedVocational Rehabilitation of Disabled Persons (VREDP) that has assisted 500disabled adults, 40 % of them women, to become self-reliant by giving Rs.5,000/- credit at 8% interest, in addition to helping them in setting up smallbusinesses. The loan recovery rate is reportedly 99%. The VREDP has also beenable to find jobs for the PWDs. Over the year, it helped find jobs for some 200disabled who had been suitably trained, in factories around Lahore with the helpof the Lahore Chambers of Commerce and Industry (LCCI) and LahoreAssociation of Businessmen for Disabled (LABAD).

3.15 Medical Rehabilitation

Providing timely and effective medical rehabilitation services for persons withdisabilities affected by disease, injury or congenital impairment can contributematerially to their subsequent health, independence and personal productivity. Inthe aggregate, therefore, medical rehabilitation services are a powerful means ofcombating disability.

In Pakistan, well-documented descriptions of medical rehabilitation services arelacking from available literature and databases. Generally, most medicalrehabilitation practices on the part of physicians, surgeons and nurses have beendeveloped during the course of service provision rather than as part of a formaltraining. Medical rehabilitation programmes provided at the National Institute forHandicapped (now renamed National Institute for Rehabilitation Medicine) arenot exclusively dedicated for the handicapped. NIH could not convincingly fitinto the macro model of disability. Over 60% patients attending the NIH do notmeet disabled classification. Earlier emphasis was upon assessment, diagnosis andtherapeutic services. This paradigm has recently shifted to rehabilitationcomponent.

The Mayo Hospital Lahore on the other hand provides a model that promotesinterdisciplinary interaction in medical rehabilitation education, training and

research. The Department of Medical Rehabilitation is one a kind in the countrywherein the emphasised areas are improving functional mobility; promotingbehavioural adaptation to functional losses, developing indigenous orthotics andprosthetic technology; and training under-graduates and post-graduates in themedical rehabilitation field. Among the range of devices currently manufacturedat Mayo Hospital include artificial limbs, appliances, and body support andmobility systems. In prosthetics and orthotics, modular preparation using localcomponents and better understanding of gait and pressure distribution and higherstandard of fitting and design are maintained.

Overall, medical rehabilitation and the mainstream service delivery system ofwhich they are a part are poorly and inconsistently planned and delivered.Classification systems of disabilities and consequent rehabilitation interventions,practice modes, methods of financing and consumers’ satisfaction and preferencesare not uniformly applicable to a variety of present day services and systems ofcare. In this regard, it is worth mentioning that existing services of the ArmyMedical Corps (AMC) can be said to be at the greatest advantage in terms ofknowledge of medical rehabilitation, outcomes, interventions and service deliverysystems.

The provision of appropriate training in the field of medical rehabilitation isextremely deficient. Service providers at district, tehsil and union council levellack well-substantiated guidelines on patient management pivotal for the field.Medical rehabilitation of the disabled generally is perceived to have low priorityin the districts as seen in the context of the Local Government Ordinance 2001.The degree to which the devolved district is able to bear the responsibilitydepends on the availability of funds and order of priority as envisaged by theelected district governments.

Physiotherapy is an important medical rehabilitation service for the disabled. Anunderlying constraint in the country is the shortage of physiotherapists and theirconcentration in cities where salaries and work conditions are better than ruralareas. The hospital-based physiotherapists in large cities tend to not provideservices beyond the walls of the hospitals unless it is regarded as private practiceafter official work hours. Home exercises are often included in treatmentprogrammes but there is no way of ensuring that patients carry them outeffectively. Rural areas with nearly three-quarters of the population are largelyneglected. Patients with acute pain in the lower back or with cervical spondilysishave to travel in uncomfortable buses to the cities for treatment. PWDs needinglong-term management, such as paraplegics and hemiplegics, are often unable toundertake such journeys; hence a majority of them opt for local treatment throughtraditional healers in their own localities.

SECTION 4: LEGISLATION AND POLICY REFORMS

This section covers the statutory measures taken by the Government and policyreforms spelled out for the welfare of the persons with disabilities.

4.1 Disabled Persons (Employment And Rehabilitation) Ordinance, 1981

Disabled Persons (Employment and Rehabilitation) Ordinance was promulgatedby the Government of Pakistan during the International Year for Disabled (IYDP)in 1981 to provide a legislative support to persons with disabilities ensuringemployment opportunities to them in open market including governmentdepartments, commercial establishments and industrial concerns. The lawprescribes a quota of one percent for compulsory employment of PWDs whichwas subsequently raised to two percent by executive order. The disabled personemployed under this quota is entitled to all the terms and conditions which will inno way be less favourable to other persons employed in that establishment.

A National Council for the Rehabilitation of Disabled has been established at theFederal level under the Ordinance to formulate policy for the employment,rehabilitation and welfare of PWDs to evaluate, assess and coordinate theexecution of its policy by the provincial councils. The major areas of interest ofthe Council include survey of PWDs in the country, medical examination andtreatment, training of PWDs and undertaking all measures required for thispurpose.

The National Council has counterparts the Provincial Councils for theRehabilitation of PWDs established in each province to execute the policy of theNational Council for the employment, rehabilitation and welfare of PWDs andundertake appropriate projects. The Provincial Councils are responsible to makearrangements for training of PWDs in such trades or vocations as it may deem fitand establish training centers for this purpose.

PWDs desirous of being employed have to get themselves registered as disabledpersons with the National Council for the Rehabilitation of Disabled Persons(NCRDP) or Provincial Council for the Rehabilitation of Disabled Persons(PCRDP). These councils certify the disability on the basis of medical disabilityassessment carried out by a Medical Board established at district levels under theChairmanship of Medical Superintendents of DHQ Hospitals on the parameterslaid down in the ordinance.

The Ordinance provides for the establishment of a fund known as DisabledPersons Rehabilitation Fund consisting of all sums paid by establishments, grantsmade by Federal Government, Provincial Governments, Local Bodies anddonations received from individuals. The amount collected has been insufficientto start any viable project for the disabled.

4.2 National Policy For Persons With Disabilities (2002)

The National Policy for Persons with Disabilities was finalized after a lengthyconsultative process involving all stakeholders and relevant Federal Ministriesincluding Health, Labour Manpower, Housing and Works, Science andTechnology as well as relevant departments and prominent NGOs.

The policy acknowledges the need for the provision of a comprehensive range offacilities for persons with disabilities from prenatal to postnatal period throughproper assessment education, vocational training and employment. The provisionand expansion of services of good quality require a multi-sectoral and multi-dimensional approach. This is possible only through the active cooperation offederal, provincial, local government organizations, NGOs as well as involvementof family, professionals and the community at large. The policy documentcontains a vision, guiding principles and strategies to achieve the objectives. Theoverall vision of the policy is to provide a conducive environment for therealization of the full potential of persons with disabilities leading to theirempowerment irrespective of caste, creed, colour race, or religion in all spheres oflife including social, economic, personal and political.

4.3 National Plan Of Action For Persons With Disabilities, 2006.

The National Plan of Action (NPA) suggests measures to operationalize theNational Policy for the Persons with Disabilities 2002. The NPA is based on thephilosophy that access, inclusion and equalization of opportunities for the personwith disabilities are not possible by isolated interventions. These services shouldtherefore be designed in an integrated way by pooling and mobilizing allresources. The NPA identifies 17 critical areas of intervention from assessment ofthe magnitude of the problem to service delivery systems. It spells out short termsteps to be taken by the end of June 2009 and long term measures to be adoptedby July, 2025. It contains specific time frames for the completion of each activityand assigns responsibility to various departments and agencies. The short termmeasures listed in the NPA include:

establishment of data bank;sample surveys of persons with disabilities in selected districts;reduction in incidence of disabilities through primary and secondarypreventive care, strengthening of disability prevention programmes,arrangements for early detection and institutional interventions;escalating medical rehabilitation services;promoting inclusive education;expanding and reinforcing vocational training;employment including self employment;

legislative support to persons with disabilities; andboosting up public opinion and increasing support to NGOs.

The long term objectives reflected in NPA focus on creation of barrier freephysical environment for PWDs in all public, private and commercial buildingsand public places and revision of construction bye laws. More effectiveenforcement and expansion of social assistance and social security programmeunder the provisions of existing laws would be beneficial.

4.4 Minimum Accessibility Standards (a)

A considerable percentage of the total population suffers from some form ofdisability that limits their ability to move around in their surroundings. Unlessthese people are capable of moving around in, and using their environments, thedream of their full participation and equality within society cannot be realized. Toachieve this goal, building by-laws and codes have been formulated and enforced,making it mandatory upon owners, designers, builders and regulators of publicbuildings and facilities that all new construction meant for public use be made insuch a way it is without physical barriers and that already existing buildings andfacilities are modified to an achievable extent. The accessibility code prepared bythe DGSE prescribes minimum legal requirements and regulations for buildingenclosures and systems, its compliance in terms of space and material provisionscan be achieved in scores of ways.

A Design Manual and Guidelines for accessibility have also been published toprovide further explanation. The provision of Accessibility Code shall apply tothe construction, addition and alterations of all new as well as existing buildings,structures, facilities, premises and areas which are owned, occupied and managedby federal, provincial and local governments and privately-owned public servicebuildings.

The major design requirements contained in the accessibility code are as under:

4.4.1 Accessible Route

i. At least one accessible route which is unobstructed, level, continuous,illuminated and reasonably weather protected shall be provided on thepremises from parking place; site gate or entrance; and / or public street toaccessible entrance to the building;

ii. A gradient of less than 1:20 is considered level access; andiii. The width of accessible route shall not be less than 48 inches and it shall

be protected by handrail where there is a level drop of more than 18 inchesfrom the adjoining ground surface.

(a) The Accessibility code of Pakistan 2006

4.4.2 Approaches to Buildings

i. At least one of the entrances to every building on the premises shall beaccessible by a wheelchair bound person; and

ii. The entrance into the building shall give a clear opening of not less than33 inches.

4.4.3 Ramped Approach

i. Where ramps are required to manoeuvre a distance along an accessibleroute, the running slope should not exceed 1:20, and in any case shall notbe more than 1:12 for new construction;

ii. For existing development the running slope shall be allowed up to 1:8,only where an alternative stepped approach is also provided;

iii. The cross slope for an accessible ramp shall not exceed 1:50;iv. The ramp shall not be less than 48 inches wide; andv. The maximum rise allowed between two landings shall be 30 inches.

4.4.4 Outdoor Steps

i. Steps and staircases on an outdoor access route shall not be less than 36inches wide;

ii. Each step shall have a riser not more than 6 inches and a tread width of notless than 11 inches;

iii. Single steps should be avoided; andiv. All steps and staircase shall have handrail along one side at least.

4.4.5 Ground Surfaces

i. The surfaces of accessible route and its elements including, but not limitedto, ramps and steps shall be of a firm, slip-resistant and reasonably smoothconstruction especially under wet conditions; and

ii. Detectable tactile surface should be provided across the width ofaccessible route at each level change and at head and foot of ramps andsteps.

4.4.6 Handrails

i. To provide guidance and support continuous handrails should be providedalong exposed sides of the accessible route;

ii. The handrails shall be of sturdy construction, not exceeding 2 inches indiameter and shall extend a minimum of 12 inches beyond the step orramp in the running direction; and

iii. The height of the handrail from the floor surface shall not be less than 30inches and more than 42 inches.

4.4.7 Walkways

i. To allow for wheelchair users the walkways, footpaths and sidewalkpavements shall not be less than 48 inches wide; and of a clear width of 36inches at clearly identified obstruction like utility poles, trees and otherappurtenances;

ii. The gradient of walkways should not exceed 1:12;iii. All walkways shall have curb ramps conforming to ramp specifications at

curb crossings; andiv. The gratings on walkways should not have parallel bar and shall have

apertures running at right angles to the direction of travel and of size notlarger than 1 inch width.

4.4.8 Pedestrian Crossings

i. All marked pedestrian crossings on the roads shall be provided with curbramps and detectable floor paving;

ii. The pedestrian crossings shall be clear of obstructions along the roadwidth and should have guiding rails at the curbs;

iii. Where possible auditory signals and manually operated traffic lightsshould be provided at road crossings in areas of high pedestrian traffic;and

iv. Safe traffic islands to reduce the length of the crossing are recommendedfor the safety of all road users.

4.4.9 Vehicular Parking

i. Parking facilities shall be accessible through an accessible route and atleast one floor of a multi-story indoor parking facility shall be servedeither by an accessible elevator or an accessible ramp;

ii. For car parking places requiring a minimum of twenty and maximum offifty parking spaces at least one dedicated parking space shall be reservedfor the exclusive use of drivers or passengers with physical disabilities;

iii. Where car parking requirements exceeds fifty spaces in number, aminimum of two percent of parking spaces shall be so reserved;

iv. For motorcycle and bicycle parking places requiring a combined minimumtotal of at least fifty spaces, one parking space for adapted tricycle ormotorcycle meant for the use of persons with physical disabilities shall bereserved;

v. Where bicycle and motorcycle parking requirements exceed fifty, aminimum of four percent of parking spaces shall be so reserved; and

vi. The reserved parking spaces shall be located in clear view of and nearestto the accessible entrance to the building or facility.

4.4.10 Parking Space Dimensions

i. The width of an accessible reserved parking space for a car shall not beless than 12 feet, inclusive of a 48inches wide accessible aisle;

ii. A 48 inches wide access aisle may be shared between two adjacent carparking spaces;

iii. The width of an accessible reserved parking space for adapted motorcycle/ tricycle shall not be less than 6 feet;

iv. For indoor parking, the minimum height clearance for accessible parkingshall be maintained as 8 feet; and

v. All parking spaces reserved for the use of drivers or passengers withdisabilities shall be clearly identified on the ground surface withinternationally accepted markings.

4.4.11 Public Toilets

i. Public toilets in outdoor facilities and along public streets should beprovided at convenient locations and preferably in close proximity tomosques and public parks;

ii. Each location of public toilets shall have at least one unisex toilet for useby persons with disabilities;

iii. The unisex public toilet shall be accessible and usable by persons withdisabilities of either gender and shall be equipped with usable wash handbasin, European type water closet, grab bars, running water, and workableillumination; and shall be large enough to accommodate one wheelchairbound person accompanied by an attendant of either gender; and

iv. The accessible toilet shall be identified with accessibility signs for visualand tactile identification.

SECTION 5: MAJOR CHALLENGES AND CONSTRAINTS

The identification of challenges faced by persons with disabilities andorganizations working for their welfare is of paramount importance. Thisimportant aspect has remained neglected in the past. No scientific study or surveyat national level was ever conducted to comprehensively asses the problems ofthis marginalized segment of the society. However, inferences or conclusionsdrawn from the various micro studies carried out from time identify the followingchallenges and constraints which were also duly endorsed, as well as refined, byvarious stakeholders during focus group discussions held at Peshawar, Lahore,Karachi and Islamabad during April 2008.

5.1 Absence of Coordination and Networking Mechanisms

There are several public sector and civil society based organizations working forthe welfare, rehabilitation and socio-economic uplift of persons with disabilitiesbut no national level network exists to provide them a platform to undertakegreater advocacy and make themselves more visible to key stakeholders. Even acommon web-site does not exist whereby persons with disabilities and others canknow about the work of these organizations. This results in duplication of efforts,absence of strong advocacy and lobbying and lack of linkages with donors,general public and persons with disabilities.

Same is true for person for disabilities who are not networked with each other andare not aware of the full range of facilities and services offered by variousorganizations. This keeps them marginalized and detached from the rest ofsociety.

5.2 Lack of Reliable Data

The basic problem identified in all key reports is the non availability of accurateand reliable data about the magnitude or prevalence of disability in Pakistan. Thisdoes not help in proper planning and policy making. In the absence of nation-wideand accurate data collection methodologies, reliability of current data wouldremain questionable.

5.3 Inappropriate Need Assessment

The ownership of any programme largely depends upon the common needs of thebeneficiaries and key stakeholders. However, in Pakistan no scientific effort hasbeen made to assess the real needs and problems of the PWDs.

5.4 Inadequate Policy, Legislative and Enforcement Framework

Pakistan is yet to sign and ratify the UN Convention on the Rights of Persons withDisabilities. However, the present government plans to do so at the earliest.

The Disabled Persons (Employment and Rehabilitation) Ordinance 1981 does notcontain an effective mechanism for the employment and rehabilitation of PWDsdue to number of lacunae in the Ordinance. The amended Ordinance underconsideration of the Government is yet to be approved.

Even the existing policies and laws for the welfare of PWDs are not beingfollowed strictly due to weak enforcement mechanisms and lack of awareness onpart of major decision makers. For example, the 2% quota in all jobs reserved forPWDs is not being followed but there is no mechanism to ensure itsimplementation.

5.5 Lack of Community Based Programmes

In Pakistan, disability had for long been considered a medal problem and the statewas considered to be responsible for addressing it. Thus, the concept ofcommunity based rehabilitation and education programmes could not flourishmuch. This trend has changed over the years due to the efforts of numerous NGOsand other civil society and corporate sector institutions but we still need to do alot.

The role of media in changing society’s view of disability and disabled people isvital but there is no tangible communication between the media and organizationsserving and representing the rights of persons with disabilities.. The importantissues facing people with disabilities in Pakistani society include the perceptionsby the society that disabled people deserve segregated educational facilities andexclusion from regular educational system. Hence “inclusive education” forpersons with disabilities has also remained an exception.

5.6 Shortage of Human Resource

The position with regard to the availability of trained and qualified teachers hasimproved considerably in big cities like Lahore, Karachi and Islamabad with theestablishment of training institutes including Departments of Special Education inPunjab University, Karachi University and AIOU Islamabad. But the institutionsestablished at other places mostly lack trained and qualified teachers.

Similarly there is an acute shortage of allied technical staff in the existinginstitutions which include audiologists, speech therapists, physiotherapists andoccupational therapists.

5.7 Inadequate Resources

Social Welfare & Special Education” has been an integral part of developmentplanning in Pakistan but this sector has always remained at the lowest priority inresource allocations (except for a few years in the early 1980s). The developmentbudget allocated to the Federal Ministry of Social Welfare & Special Educationduring the last 4 years is reflected below:

(Rs. in million)Years PSDP Allocation

2004-05 303.528

2005-06 148.294

2006-07 222.598

2007-08 241.017

Source: Directorate General of Special Education, Government of Pakistan

The private sector and civil society is contributing a lot for supplementing theefforts by the government but no reliable data is available about their investments.But like many NGOs in other sectors, it is felt that majority of well meaningNGOs working for PWDs struggle to maintain financial sustainability.

Micro credit facilities that help in gaining self employment, leading to greatersocio-economic empowerment, are rarely made available by most institutions toPWDs

5.8 Inadequate Services and Facilities

The number of existing services and facilities for PWDs are absolutelyinsufficient and in no way correspond to the number of PWDs. The availability ofonly 531 institutions in the country for the disabled population of 3.29 million isalmost negligible. More notably the following inadequacies are worth beinghighlighted:

Urban Concentration of Services: Most of the services and facilities forPWDs are restricted to urban areas except in Punjab where special educationschools have been established at Tehsil level. Resultantly, 70% of Pakistan’spopulation, which live in rural areas, is deprived of such services;

Paucity of Vocational Training Facilities / Services: Vocational training playsa significant role in making the PWDs productive members of the society.There is a great scarcity of vocational training facilities in the country. Thevocational training being imparted is restricted only to stereo type traditionaltrades like cane work, weaving, candle making, lace making that hardlyrespond to the demands of the contemporary market;

Environmental barriers: Most of the public places in our cities, includinggovernment offices, schools, colleges, shopping malls and restaurants etc. donot provide a “barrier free” environment to PWDs. These buildings do nothave support rails, ramps or lifts to facilitate the PWDs. Even in buildingswhere there are lifts, the press buttons are beyond the reach of wheel chairusers. There are no specific seats reserved in public buses for the PWDs. Mostof the buildings of even the special education institutions are not well suited topeculiar needs of the PWDs.

Lack of workshops: There is serious lack of proper workshops and equipmentin the country. For example, physiotherapy equipment available in most of thecenters has become obsolete and needs replacement. Similarly, ortho-prosthetic workshops are available in big cities only which are hardlyaccessible to the population living in far flung rural areas. Integratedworkshops are virtually non existent whereas these are imperative for themain streaming of persons with disabilities. There are no shelter workshops inthe country where totally incapacitated persons could be provided some levelof care.

SECTION 6: PROPOSED INITIATIVES

6.1 Establishment of Coordination and Networking Mechanisms

It is proposed that a national network of organizations working for persons withdisabilities may be established to provide a neutral but powerful forum for thoseengaged in the welfare of PWDs. This network should be open to allorganizations working for PWDs, irrespective of their location, size and nature ofprogramme as long as they work for the larger good of PWDs. This networkcould provide much needed services such as development of various data bases,creation of a mega web-site, lobbying and advocacy and creating greaterawareness among key stakeholders. It will also facilitate the PWDs by providingthem information and access to the services and facilities provided by both thegovernment and the civil society.

6.2 Collection of Reliable Data

The non-availability of reliable data is a great impediment in the effectivedelivery of services to PWDs. Database provides a basis for policy making,project planning and programme implementation. There is a vital need to havereliable data about magnitude of the disability problem in Pakistan. It is,therefore, imperative that a comprehensive survey to determine the status ofdisability be carried out which should also focus on the need assessment of PWDsto develop reliable programmes for their welfare.

6.3 Scientific Needs Assessment

A comprehensive survey to asses the needs and problems of the Disabled Persons’Organizations and Institutions needs to be carried out on scientific lines to launchprogrammes for their institutional and individual capacity development.

6.4 Improvements in Policy, Legislative and Enforcement Framework

Pakistan needs to expedite the signing and ratification of the UN Convention onthe Rights of Persons with Disabilities so that it is part of the global efforts toimprove the quality of life of PWDs.

Existing policies and laws need to be refined since the only law for the welfare ofPWDs was passed in 1981 and it now needs to be brought in line with changes inthe society and advancement in various models for the rehabilitation andmainstreaming of PWDs.

Weak enforcement mechanisms need to be strengthened so that the benefitsavailable to PWDs, such as 2% quota in jobs, can accrue to them. This requiresadvocacy and lobbying with the government and corporate sector.

6.5 Increased Community Based Programmes

Most of the vocational and rehabilitation programmes tend to be centralized inlarge cities and delivered through static vocational institutions. The number ofinstitutions offering such programmes is very small, and the problem is moreserious for the disabled population living in rural areas. Villages, therefore, shouldbe the focal point of community rehabilitation programmes through a network ofcivil society and community based organizations at the grass-root level.Association for the Rehabilitation of Physically Disabled (ARPD), NWFP presenta good model that can be replicated in other rural areas.

Government’s goal of Education For All (EFA) cannot be achieved throughpresent approach of establishing and extending special education schools. There isa need for the mainstreaming of PWDs. The GoP in its perspective plan 2001-11has highlighted the need of “inclusive education” of PWDs in normal schools ofall the provinces. It is also suggested in the Plan that all schools will haveprovisions such as modification in the classroom structure to ensure accessibility,training of regular teachers and provision of complementary teaching aids andequipment for the implementation of the plan. The introduction of “inclusiveeducation” on priority basis is, therefore, highly recommended for those PWDswho able to participate in such programmes;

Contemporary shifts in models of social development call for the promotion ofparticipatory development to create and strengthen ownership, minimize the costof delivery of services and to ensure sustainability of programmes for PWDs. Thefuture strategy should, therefore, be directed towards initiating Public-PrivatePartnerships between government and CSOs. This will help in mobilizingcommunity resources for filling the resource gap. The possibilities of adoptingspecial education institutions by the corporate sector may also be explored toshare the burden of government.

6.6 Human Resource Development

While there are some educational institutions imparting the necessary skills andknowledge to special education teachers, technical staff and social workers in thefield of disability, but their number and out put is very small compared to thehuman resource requirements of the country. The number and output of suchinstitutions and programmes need to be increased manifolds.

Distance learning programmes need to be launched in the rural areas to create acadre of social activists and workers focused on this vital sector. Formaleducation system, particularly the teacher education programmes, needs tointegrate “special education” into their curricula to create more awareness amongteachers in the formal education sector.

6.7 Resource Mobilization

“Social Welfare and Special Education” is now the responsibility of District / Citygovernments, under the Devolution Plan. This has led to some uncertainty aboutthe adequate funding of programmes for persons with disabilities. This calls forgreater contribution by the society, particularly the corporate sector. NGOs /CBOs working at grass root level should be provided all possible financial andtechnical assistance for the purpose of their capacity building to launch larger andmore effective programmes. New avenues of national and foreign assistance needto be explored for combating resource constraints in an effective way. An apexorganization in the private sector may be created for coordination withgovernment as well as NGO, preferably through their Corporate SocialResponsibility programmes.

Training PWDs in agro-based trades can also help them in becoming self reliantmembers of the society. Majority of disabled population live in rural areas with noaccess to credit. Financial support should be provided to PWDs, through ZaraiTaraqiati Bank, Khushali Bank NRSP, and RSPs who have their network atdistrict level and rural areas. The funds may be provided for starting smallbusiness like bee-keeping, poultry, fish-farms, diary development and other agrobased income generating trades.

The possibilities of establishing a National Finance and Development Corporationfor PWDs, on the pattern of a similar organization in India, needs to be consideredseriously.

The existing social assistance programmes for the poor in Pakistan through Zakatand Bait-ul-Mal in the form of Food Support Programme, Guzara Allowance,Marriage Assistance are not responsive enough to cater to the growing needs ofmarginalized groups including PWDs. “Social protection” programmes can be aneffective mean of strengthening poor peoples’ capabilities to mitigate and managerisk and vulnerability, thus impacting positively on underlying poverty andinequality.

6.8 Provision of Suitable Facilities and Services

Increased rural spread: Most of the PWDs live in the rural areas but thefacilities are concentrated in urban areas. This is mostly due to availabilityof trained human resource and other resources in larger cities. There is anurgent need to cater to the needs of PWDs in rural areas through theextension of facilities and services beyond urban centers;

Better vocational education facilities: Vocational education programmesneed not only to be expanded but their curricula needs to be in line withcontemporary market requirements;

Improved accessibility: All public buildings and facilities need to have“barrier free” environment for PWDs. This requires a mass awarenesscampaign as well as early approval and enforcement of the Building Codedrafted by the Government to increase access in buildings;

Better workshops: Sheltered workshops required for severely handicappedpersons are almost non-existent in Pakistan. A few such projects may beestablished in bigger cities to provide opportunities of supportiveemployment for PWDs. Similarly, few ortho-prosthetic workshops existboth in the public and private sectors which are inadequate to cater to thegrowing needs of the PWDs. Such workshops, with trained technicians andqualified staff, should be created at district level.

Industrialization and urbanization has resulted in the breakdown of ourtraditional joint family system which poses new problems particularly toPWDs, since there is no one to look after them at home. The totallyincapacitated children and elderly persons are leading miserable lives. Eventhe few homes established by Edhi Foundation do not have the desiredarrangements backed by trained nurses, para-medics and technicians. Theestablishment of well equipped and properly staffed homes for the totallyincapacitated is strongly recommended;

Annexure I

Recommendations of theFocus Group Discussion at Peshawar

(April 2, 2008)

The following recommendations were made at this meeting:

Networking

A National Network for Organizations/Persons with Disabilities may be formed atnational level for undertaking advocacy and giving their advise in planning andexecution of programmes relating to persons with disabilities; and

We may study the National Forum of Organizations Working for Persons withDisabilities I Bangladesh to establish a similar network in Pakistan.

Awareness Raising/Information Sharing

Aggressive awareness raising campaign through electronic and print media may belaunched as a continuous process for highlighting the issues and promoting existingfacilities available for persons with disabilities;

Outstanding achievements made by persons with disabilities need to be highlightedthrough media for encouragement of persons with disabilities and their parents;

2009 may be declared as the Year of the Disabled;

An Annual Convention of Persons with Disabilities may be organized; and

A mechanism to share information related to persons with disabilities andorganizations working for them may be created (e.g. development of a one stopweb-site);

Community Based Programmes

On priority basis, rural community based programme for persons with disabilitiesneed to be planned and established for the benefit of larger portion of persons withdisabilities since most programmes tend to be concentrated in urban areas.

Enforcement

An effective and efficient mechanism may be developed to ensure strictenforcement of 2% quota for employment of persons with disabilities;

Strict adherence to the recently developed building codes and by-laws for increasedaccessibility of persons with disabilities may be ensured; and

A Disability Tribunal may be created on the patterns of Federal Services Tribunal toensure compliance with laws, policies and rules related to persons with disabilities.

Facilities

Interest free micro-credit facilities may be established for persons with disabilitieson personal surety basis;

Promotion of research on issues of persons with disabilities by public and privatesector organizations should be encouraged.

Annexure II

Recommendations of theFocus |Group Discussion at Lahore

(April 5, 2008)

The following recommendations were made by the participants:

Networking

A central coordination council for the organization of the persons with disabilities(PWDs) may be created to solve their problems; and

It was also felt essential to avoid overlapping, duplication of services and ensuringeffective referral services keeping in view the peculiar needs of the PWDs.


The development of a website for PWDs was considered to be essential;

The participants urged upon the need of setting up a separate T.V. channel for massmotivation, advocacy and disability sensitization to wash out the stigma attached tothe disability;

Print and electronic media should be sensitized to project the abilities andpotentialities of PWDs;

Out reach programme for family-counselling and guidance be initiated;

The subject of special education be introduced in F.A, B.A., PTC, CT, B.Ed:, levelsto acquaint the students and teachers about the needs and problems of PWDs; and

Mobile training courses at district and grass-roots level are organized, being costeffective and less time consuming.

Inclusive Education

There was a difference of opinion among the participants on integrated (i.e.inclusive) education of disabled children in normal schools;

The discussion, however, culminated on the consensus of opinion that inclusiveeducation could be started with due care and caution after sensitizing the parents,teachers, students and communities and with the provision of essential equipmentwhere needed (an example of 1300 schools in Punjab was given where inclusiveeducation was already being practiced amicably).

Enforcement

The existing law titled Disabled Persons (Employment & Rehabilitation)Ordinance, 1981 was considered highly defective and it was recommended that theamended law which had been under considerations of the standing committees ofNational Assembly and Senate may be expedited and got passed from theparliament;

Great concern was shown on the poor preference of the National Trust for theDisabled Persons which has utilized its corpus on the construction of DirectorateGeneral of Special Education buildings. The similar trust established at Punjab hadincreased its funds and assets from Rs. 10 million to Rs. 44 million;

The out put of the National Council for the Rehabilitation of Disabled Persons wasalso considered to be much below the desired standard that warranted itsrevitalization; and

Effective monitoring and evaluation system with objective analysis may be initiatedand an annual report be published.

Facilities

Emphasis should be laid on prevention, early detection and intervention tominimize the incidence of disability;

Micro-credit facilities should be provided to PWDs to promote self-employmentopportunities leading to their socio-economic empowerment;

It was observed that the existing services for the disabled children could cater onlyto 4% of the children where as 96% of the children were out of school that requiredthe expansion and extension of services;

Establishment of homes for the incapacitated persons/children was considered to beessential and it was suggested that immediate measures should be taken for setting-up of these homes;

The possibility of starting genetics focused programmes to prevent the chances ofdisability through schemes like pre-marriage blood tests be explored;

School health programme was considered to be essential to facilitate early diagnosis/ assessment of disabilities among children;

The possibility of setting-up of a Marriage Bureau for the PWDs be explored;

A good number of PWDs were engaged in income generating activities but the saleof their product was a big problem that required the establishment of display centersfor the sale of their products. The existing dichotomous salary structure emergingfrom the double salary package given to the special education teachers bygovernment of Punjab was likely to result in brain drain because majority of theNGOs could not afford to increase the salaries of their teachers. It was, therefore,essential to provide financial assistance to NGOs for the retention of their trained,qualified and experienced teaching staff.

Annexure III

Recommendations of theFocus Group Discussion at Karachi

(April 8, 2008)

The following recommendations were made during the discussion:

Networking

There is a general lack of coordination among organizations working for persons withdisabilities;

Lobbying and advocacy with key stakeholders is not well organized; and

Any forum to fill this gap would be a welcome addition.


Social awareness campaigns should be started through T.V. and Radio about theproblems and causes of disabilities as was largely being done in case of Polio, T.B.and AIDS;

Mobility training programme should be initiated to ensure accessibility of PWDs.Pamphlets, leaflets and brochures should be got printed and circulated for creatingmass awareness;

Parents counselling and guidance programme should be started;

Comprehensive Performa may be designed for collection of data about the disabilityduring the next population census likely to be carried out during 2008;

The media programmes on disability issues may be sponsored by the government,philanthropists and industrialists;

The subject of Special Education may be included in the PTC, CT, B.Ed.programmes. A proposal regarding this issue was reported to have been submitted tothe Curriculum Wing of Ministry of Education, Islamabad which should be pursuedvigorously;

Compulsory short-term training programmes be started for the teachers of normalschools to acquaint them with the needs and problems of PWDs;

Refresher training courses for the existing teachers of special education centers maybe organized;

Indigenous teaching material in local or regional languages should be prepared forpublic instructions through schools and mosques;

Long distance/correspondence courses may be designed for social workers in ruralareas;

Basic training to the LHVs, Traditional Birth Attendants (TBAs) and Mid-wivesshould be imparted to avoid the possibilities of disabilities during Prenatal, Peri-natal,Early Infancy and Childhood; and

Training workshops for sharing information and capacity building be held at grass-roots level. The existing special education centers established at district level could beused as focal points.

Inclusive Education

Inclusive education must be ensured for those children who did not suffer from veryserious disabilities.

Enforcement

It was observed that National Council for the Rehabilitation of the Disabled hadbecome dormant for the last four years. It was, therefore, essential to reactivate theCouncil;

A Tribunal may be set up to ensure 2% quota in all jobs for PWDs;

Nikah Nama should have a leaflet attached about disabilities and preventive measuresto avoid it in children; and

Monitoring and Evaluation Programmes for PWDs be carried out in consultation withservice providers.

Facilities

The participants highlighted the need of prevention, early detection and interventionsto prevent the growth of incidence of disabilities;

It was stressed that there were about 21 genetically transmitted diseases that could beaverted if the blood test was made mandatory before marriage through an act of theparliament. Such laws and measures existed in Islamic countries like Turkey and Iran;

Facilities and services for the PWDs were largely concentrated in urban areas hence itwas essential that special education programme should be expanded and extended inrural areas to reach the un-reached;

The procedure of getting railway concession for visually handicapped persons shouldbe simplified and made available at all railway stations instead of only at commercialoffices of railway located at Karachi and other big cities;

Braille books and other teaching material may be provided in greater numbers toNGOs;

The possibility of establishing an Equipment Bank be explored;

Micro-credit facility should be provided to PWDs. The existing limit of Rs. 5000/-was considered to be too meagre to start any business;

Mushroom growth of MCH centers was considered a major factor for causingdisability during prenatal care and delivery procedure. The establishment orcontinence of MCH centers without qualified LHVs and medical staff should bediscouraged / banned;

Identity cads for the PWDs may be prepared;

A uniform procedure to get Medical Assessment Certificate should be designed;

Uniform curriculum for PWDs may be developed;

Recreation facilities may be provided to PWDs; and

Financial assistance to NGOs for fuel charges and purchase of school transport /buses may be provided.

Annexure IV

Recommendationsof the

Focus Group Discussion at Islamabad(April 12, 2008)

The participants offered the following advice to refine the draft research report:

It was observed that the report was more institutional based. There was a paradigmshift from medical rehabilitation to socio-economic / community based rehabilitationthat required the highlighting of community based rehabilitation programme – (theconsultants replied that this was done in the report but not fully highlighted in thepresentation)’

Chromosomal / genetic causes seemed to have been omitted which may be includedto highlight the need to prevent the genetically transmitted diseases;

The report mainly focused on four categories of disabilities whereas the internationalclassification of disability included many other categories which may be incorporatedin the report, particularly “autism”;

The term “hearing impaired” did not include persons with speech impairment. Therewere many people who could hear normally but their speech was impaired because ofa stroke. Hence “speech impairment” should be treated as separate category;

The use of the word “disabled” was considered to be incompatible with normalhuman dignity. The latest term was “persons with disabilities” and it should be usedas far as possible; and

WHO had done a new reclassification of disabilities in 2001 which may be referred toin the report.

All points were well taken by the authors and they promised to include them in therevised version.

The participants highlighted various other issue and possible remedies. Salient points oftheir feedback are given below:

Networking

A great concern was shown on the lack of coordination among Disabled Persons’Organizations (DPOs);

The need for establishing a Coordination Council was strongly felt;

Any such network must have specialized groups for each of the main disabilities;

The participants referred to the creation of an NGO network to avoid overlapping andduplication and ensuring optimum use of meagre resources; and

The suggestion of developing better cooperation and coordination with SpecialEducation Department, Allama Iqbal Open University (AIOU) and placement of theirstudents for fieldwork was agreed.


Mass motivation, mass education and advocacy programmes through print andelectronic media were considered to be essential to bring about an attitudinal changein the society;

The Directorate General of Special Education and NCSW were reported to haveprepared a project for this purpose;

The film recently released (Taare Zameen Par) was highly appreciated and it wasurged to have more of such initiatives;

The participants stressed upon the genetic counselling and guidance to discouragecousin and inter marriages to minimize the incidents of disability;

It was observed that there were about 50 private channels. The possibility of askingthem to donate 5 minutes time free of cost may be explored to solve the problem ofmass motivation and advocacy; and

A web-site for visually challenged was also recommended,

Inclusive Education

There was a difference of opinion about the introduction of inclusive educationalthough it was agreed that the goal of Education for All (EFA) could not be achievedwithout inclusive education.;

The experience of integrating the deaf and visually handicapped children wasreported to have been proved unsuccessful. It was, therefore, not prudent to thrust thisidea at the cost of the education of the children;

It was informed that the Punjab Government had already established SpecialEducation Centres at tehsil level and was planning to extend the services to UnionCouncil level;

It was pointed out that out of 700, 000 school age children with various disabilitiesonly 30, 000 were in the schools that constituted only 4% of the children of schoolgoing group that necessitated the introduction of inclusive education; and

There were reservations on the viability of community based rehabilitationprogrammes because many efforts made in the past had not yield the desired resultsbecause of poor socio-economic conditions of the local communities.

Enforcement

It was urged that Pakistan should ratify the UN Convention on the Rights of theDisabled;

It was clarified that there was a difference between signing and ratifying theconvention. 120 countries of the world had signed this particular UN Conventionwhile only 21 countries had ratified it;

It was also informed that Pakistan would soon sign the Convention;

The National Policy for Persons With Disabilities (PWDs) was not in conformity withthe UN Convention on the Right of PWDs;

The census data of 1988 on disability was considered to be unreliable due to defectivequestionnaire and lack of training and professional skills of the enumerators;

The possibility of increasing the amount charged from various establishments in lieuof non-recruitment of PWDs be looked into because most of the establishmentspreferred to pay that amount instead of employing the PWDs since the amount to bepaid was much smaller than the salary to be paid to a PWD;

It was informed that an Accessibility Code for PWDs had been prepared andcirculated among concerned departments that approved building plans. A law to makeit mandatory was under process;

A special cell for the implementation of the National Plan of Action for the PWDshad been created to oversee its progress;

A great concern was shown that neither there was a Special Education Department inAJK nor any one was aware of the Disabled Persons (Employment & Rehabilitation)Ordinance, 1981 which had been adopted by the Government of AJK. No MedicalAssessment Board had been constituted at the district level except one atMuzaffarabad;

The participants desired that Aga Khan Foundation may look into the possibility ofestablishing a centre of excellence for PWDs in Northern Areas. The DGSE had

already taken an initiative and constructed the building of the centre for PWDs inHunza on a plot donated by the locals;

The data regarding the number of disabled persons employed against 2% quota couldbe ascertained from the NCRDP and amount collected in lieu of recruitment fromNTD, Islamabad;

The emphasis should be laid on prevention, early detection and early intervention;and

It was clarified by the Director General, DGSE that they were developing acomprehensive questionnaire for the national survey on disability, which would befinalized in consultation with all stakeholders within next two weeks.

Facilities

The need for capacity building of DPOs was strongly felt;

It was recommended that new avenues of teachers training, including foreign training,may be explored;

The participants appreciated the outstanding performance of PWDs in sportscompetitions and securing third and sixth position in the CSS examination during thelast three years;

The possibility of developing sign language directory by the NISE may be explored;

The need for the provision of audio visual aids and hearing aids was also greatlystressed;

It was informed that the development of a uniform curriculum / syllabus for thechildren with disabilities was not possible because of a number of secondary boardsworking in different provinces and frequent changes made in the syllabus; and

The prose and cons of producing Braille books at the national and provincial levelwere discussed at length. It was found to be feasible to produce books at central level.Aziz Jehan Begum Trust, Lahore was quoted to be the best model for it.

Annexure VLIST OF PARTICIPANTS

Focus Group Discussion held at Peshawar(April 2, 2008)

S. No Name Organization / Address01. Mr. Qari Saad Noor Pakistan Association of the Blind NWFP,

PAB House, Haider Shah Town, Dalazak Road, Peshawar.02. Yasir Hayat Khan Rehabilitation Center for Physically Disabled (RCPD)

Umeedabad, No. 2, Swati Gate, Peshawar03. Syed Shahid Akram Special Education Complex, MRC, Peshawar, M/o SW&SE,

Govt. of Pakistan, Phase-V, Hayatabad, Peshawar.04. Ms. M. Raheel

ShireenSpecial Life FoundationFlat # 2nd, 3rd Floor, Silicon Center, University RoadPeshawar.

05. Mr. Arbab Khan Social Welfare and Special Education Department, Govt. ofPakistan, Khyber Special Education Center for HearingImpaired Children, Phase-V, Hayatabad, Peshawar

06. Mr. Yasin Wali Institute for Physically Handicapped Children,Opp. Sui Gas Head Office, Phase-V, Hayatabad, Peshawar

07. Mr. Mir AkramShah

Special Education Center for Visually Handicapped Children,Special Education Complex, Phase-V, Hayatabad, Peshawar

08. Mr. Ahmed Saleem Government School for HIC, Gulbahar, Peshawar

09. Dr. Fakhr-ul-Islam Director, Social Welfare & Women DevelopmentDepartment, Opp. Islamia College, Jamrud Road, Peshawar

10. Mr. Afsar Khan Social Welfare Department, Govt. of NWFP,Directorate of Social Welfare & Women Development,Jamrud Road, Opp. Islamia College, Peshawar

11. Mr. Oliver Caleb Mental Health Center, Mission Hospital Compound, DubgariGardens, Peshawar Cantt.

12. Mr. MuhammadBashir

Social Welfare Department, Govt. of NWFP,Opp. Islamia College, Jamrud Road, Peshawar

13. Mr. IkramullahDaudzai

Special Persons Development Association (SPDA),Village Muslimabad, P/o Bakhshi Pull, Charsadda Road,Peshawar

14. Mr. Javed Khan Special Persons Development Association,Village Muslimabad, Bakhshu Pul, Charsadda Road,Peshawar

15. Mr. Farhad AliRabbani

Anjuman-e-Naujawanan,Gulbahar Colony No.2, Mardan Road, Charsadda

16. Mr. Dawood Khan P.T.A, Muhammad Azam Khan Special Education Center,Gulbahar Colony No. 2, Mardan Road, Charsada

17. Ms. Shaheen Bano Govt. School for Deaf Girls, Yakatoot,49/A, Hussainabad, Gulbahar, Peshawar

18. Mrs. ShakeelaFarooq

Center for Speech and Hearing,Sector-A, Street-01, Sheikh Maltoon, Mardan

19. Ms. Sadia Jabeen Gender Analyst, Zakat, Ushr, Social Welfare & WomenDevelopment Department,Room No. 309, Benevolent Fund Building, Peshawar

20. Ms. Saira Qadir Rehabilitation Center for Physically Disabled (RCPD),Umeedabad No. 02, Swati Gate, P.O. Box-201, Peshawar

21. Mr. Amir SohailSaddozai

SAHARA Voluntary Social Welfare Agency for PWDs,SAHARA Square, Near District Courts, GPO Box-01, DeraIsmail Khan

22. Ms. Lubna Riaz Zakat, Ushar, Social Welfare and Women DevelopmentDepartment,Benevolent Fund Building, Peshawar

23. Ms. Sumbal Sheikh Zakat, Ushar, Social Welfare and Women DevelopmentDepartment, Benevolent Fund Building, Peshawar

24. Ms. Sana Amin Zakat, Ushar, Social Welfare and Women DevelopmentDepartment, Benevolent Fund Building, Peshawar

25. Mr. MuhammadNawaz

National Council of Social Welfare, Govt. of Pakistan,3-D Plaza, G-7 Markaz, Islamabad

ORGANISORS

26. Gul Najam Jamy Programme Manager, CSP, Aga Khan Foundation (Pakistan),Islamabad

27. Malik MumtazHussain

Consultant, Islamabad

28. Mukhtar Ahmad Consultant, Islamabad

29. Syed Izhar Hussain Consultant, Islamabad

Annexure VILIST OF PARTICIPANTS

Focus Group Discussion held at Lahore(April 5, 2008)

S.No Name of Participant Organization / Address01. Mr. Irshad Waheed Social Welfare, Women Development &

Bait –ul-Mall, 41- Empress Road, Lahore.02. Mrs. Aqeela Ashfaq

SahibzadaAl Qasim Institute for MRC, IslamPura,Jehlum.

03. Mr. Afzaal Humayon Voice of Specials, E-99, Fateh AbadColony, Lahore Cantt.

04. Mr. Azhar Sajjad F.G Hajwairy Special education Centrefor visually impaired children ,45-B JoharTown, Lahore

05. Mr. Naveed Khurram Qadir Foundation Behal Road,Tehsil &District Bhakkar.

06. Mr. Sajjad Ullah khan M/o Social Welfare & Special Education,I.P.H.C 45.B-II, Johar Town, Lahore

07. Mrs. Shahena Malik M/o Social Welfare & Special Education,I.P.H.C 45.B-II, Johar Town, Lahore

08. Mr. Suhail Masood Secretary, Government of Punjab, SpecialEducation Department, 31-Sher ShahBlock, Garden Town, Lahore

09. Mohammad Fazilcheema

Special Education Department, 31-SherShah Block, Garden Town, Lahore

10. Mrs. Rahila Farooq Institute for Disadvantaged ChildrenFountain House, 37 Lower Mall, Lahore.

11. Mrs. Afifa Iftikhar Government In service Trg College forthe Teacher of Disabled, 31-Shere Block,New Garden, Lahore

12. Mr. Justice (R)AamerRaza

54-A, Block 5 Gulberg 3, Lahore

13. Mr. MuhammadSalahuddin Jeddy

Aziz Jehan Begum Trust for the Blind,Suite-03, Ijaz Centre Main Block,Gulberg –II Lahore

14. Mr. Sultan Azam Department of Special Education 31-Shere Block, New Garden, Lahore

15. Mrs. Nuzhat Rubab Pakistan Society for the welfare ofMentally Retarded Children, AminMaktib, 54-A Block-J Gulberg –III,Lahore

16. Mrs. Khawar Sultana Institute of MR Children, 54-J Gulberg-III, Lahore

17. Mrs. Ursula .N. Jeddy Aziz Jehan Begum Trust Institute for theBlind 11-Awaisia Society, Lahore

18. Dr. Qamar Rasheed Hamza Foundation, 152-J-I, Johar Town,Lahore

19. Mrs. Rabia Arif Pirzada Hamza Foundation, 152-J-I, Johar Town,Lahore

20. Maj® Syed Burhan Ali NAB (Rawalpindi)21. Mr. Mian Muhammad

ArshadNational Management College (SeniorManagement Wing) NMC Hostel, 70-BRailway Burt Colony, Lahore

22. Mr. Sohail QadeerSiddique

National Management College(ServiceManagement Wing) NMC Hostel, Lahore

23. Dr. MohammadJehanzeb Khan

Member, Planning & Development Board,Civil Secretariat, Lahore

24. Dr. Abdul Hameed Ex. Chairman, Department of SpecialEducation, University of Punjab, 280Qayyum Block, Mustafa Town, Lahore

25. Mr. Waqar AhmadAwan

Social Welfare, Women Development &Bait-ul-Mall, Social Welfare ComplexTown Ship, Lahore

26. Mr. Ismail MahmoodQurashi

Home for Disabled Social WelfareTraining Complex, Near Umar Chowk,Lahore

27. Mr. Parvez Masud Pakistan Society for Rehabilitation ofDisabled, 578-G.G. Defense /III Feroz PurRoad Lahore.

28. Mrs. Parveen Umar Pakistan Society for Rehabilitation ofDisabled, 578-G.G. Defence /III FerozPur Road Lahore.

29. Mr. Mohammad ZafarIqbal

Shalimar Special Education HigherSecondary School 45-B-II M.A JoharTown Lahore

30. Mrs. Farzana Javed M/o Social Welfare & Special EducationDirectorate General of Special Education,45-B –II.M.A Johar Town, Lahore

31. Mrs. Samina Saleem Government Central High School forDeaf 40.T Gulberg II, Lahore Cantt

32. Mrs. Nabeela Ahmad Social Welfare Women Development &Bait –ul-Mall, 41 Empress Road, Lahore

33. Mrs. Rizweena Javeed Social welfare Department, 41, EmpressRoad, Near Shamila Phari, Lahore

34. Mrs. Samia Mahmood Social Welfare Women Development &Bait –ul-Mall, 41 Empress Road, Lahore

35. Mrs. Farhat Akram Social Welfare Women Development &Bait –ul-Mall, 41 Empress Road, Lahore

36. Mr. Saqib Raza Social Welfare Department, NigehbanCentre Behind Los Feroz Pur Road,Lahore

ORGANISORS

37. Gul Najam Jamy Programme Manager, CSP, Aga KhanFoundation (Pakistan), Islamabad

38. Malik Mumtaz Hussain Consultant, Islamabad



Annexure VIILIST OF PARTICIPANTS

Focus Group Discussion held at Karachi(April 8, 2008)

S. No Name of participant Organization / Address01. Mr. Manzoor Hussain Bhutto Education Department DEWA Academy

DEWA Academy KarachiResidential , C-41, Shahbaz Town, P/O BhittaiNagar, Hyderabad

02. Mr. Rizwan Ahmed Lodhi DEWA TrustDEWA Complex, St # 9, Block – 3 Gulshan –e-Iqbal Karachi

03. Mr. Muhammad Hanif Pakistan Eye Bank Society14/B, St # 17/9, Near Nagar Chorangi, Karachi

04. Mrs. Farhat Swaleh Al- Shifa Karachi AirportTerminal 2 Road Airport

05. Dr. Mahmood Raza Institute of Special Children80-B/E Block-5, Satellite Town Quetta

06. Mr. Shahid Ahmed Memon Pakisan Disabled FoundationBlock 14, Naseerabad, Behind Soneri Bank , F.B.Area Karachi

07. Ms. Zainab Meher Hasan Association for Children with Emotional LearningProblems (ACBLP)197/8 Rafiqui Shaheed Road Opposite SindhMedical College Karachi

08. Mrs. Yasmeen Akbani Association for Children with Emotional andLearning Problems197/8 Rafiqui Shaheed Road Opposite JPMC,Karachi

09. Mrs. Qudsia Khan Ida Rieu School and College for Blind and DeafNear Old Exhibition Nizami Road Opposite M.AJinnah Road Karachi

10. Mrs. Naseem Sadiq IDA RIEU School & CollegeIda Rien School for Deaf & Blind Nizami RoadKarachi

11. Ms. Zehra Jamal Special Education Govt. of Pakistan31 St Block 15 Gulshan –e- Johar Karachi

12. Mr. Riaz Fatima Social Welfare Department Govt of SindhS.T. 4, Block-7 Gulshan-e- Iqbal Karachi

13. Mrs. Shahzadi Baloch Social Welfare DepartmentS.T Gulshan-e- Iqbal Karachi

14. Mr. Abdul Khalique Solangi Qaideen Special Education CentreBlock-15 St. 31 Special Education ComplexGulistan-e- Johar Karachi

15. Mr. Muhammad AslamIsmail

Shaheed-e- Millat Special Education Center forVisually Handicapped ChildrenSt. 31, Block-15, (Special Complex) Gulstani –e-Johar, Karachi

16. Mrs. Shagufta Shahzadi Department of Special EducationSheikh Zayed Islamic Centre University of Karachi

17. Mr. Muhammad Aftab Khan Govt of Pakistan National Council of SocialWelfare, Islamabad

18. Mrs. Naureen Bashir Social Case WorkerQuaiden Secretariat / MRC KarachiSt-31 Block 15, Gulistan-e- Johar Karachi

19. Mr. Nizamuddin Social Welfare DepartmentBlock-79, Sindh Secretariat Opposite M.P.A HostelKarachi

20. Mrs. Kishwar SultanaSiddique

Directorate General of Special EducationSt. 31, Block-15, Gulistan-e- Johar, Karachi

21. Mrs. Mariam Ibrahim Social Welfare DepartmentR, 85, Salman Garden Malir Karachi

22. Mrs. Mumtaz Qurashi P.C.R.D.P Social Welfare Department Govt ofSindh.

23. Mr. Sunil Kumar Directorate General of Special EducationGulshan-e- Johar Block 15 St.31- Karachi

24. Mrs. Musarrat Jehan Quaideen Special Education for MRC Karachi31 Street Block 15 Gulistan-e- Johar Karachi

25. Mrs. Shaheena Begum (Special Education Centre for Hearing ImpairedChildrenSt. 31-Block – 15, Gulistan-e- Johar, Karachi

26. Mrs. Sabiha Haider Quaideen Special Education Centre for MentallyRetarded Children, KarachiOff. St. 31-Block 15, Gulistan-e- Johar Karachi

27. Mrs. Shabana Tabassum Special Education Centre KarachiSt 31-Block 15 Gulistan-e- Johar Karachi

28. Mr. Muhammad Ashrafi Special Education (V.R.E.D.P)St. 31Block – 15 Special Education ComplexGulistan-e- Johar Karachi

29. Mrs. Ratna Deewan Quaideen Special Education for MRC KarachiBlock 15, St. 31 Gulistan-e- Johar Karachi

30. Mr. Azhar Mahmood Directorate General of Special EducationSpecial Education Complex, Gulistan-e- Johar,Karachi

ORGANISORS

31. Gul Najam Jamy Programme Manager, CSP, Aga Khan Foundation(Pakistan), Islamabad




Annexure VIIILIST OF PARTICIPANTS

Focus Group Discussion held at Islamabad(April 12, 2008)

S. No Name Organization / Address

01. Rais Jahangir Ahmad Chairman, National Council for Social Welfare, G-8Markaz, Islamabad.

02. Ms. Abia Akram Handicap InternationalHouse # 137-B St # 43 F. 10/4, Islamabad

03. Mrs. Pakeeza Musarrat STEPHouse # 35-C St. # 30 G6/2, Islamabad

04. Mr. Muhammad IshtiaqRattu

Society for the Mentally Handicapped Children20-B Satellite Town, Rawalpindi

05. S. M Husnain Gillani Ibteda FoundationVision Public School SystemP.D-1067 St. # 2 Pindi Stadium Road, Rawalpindi

06. Mrs. Farhat Sultana National Council of Social Welfare3-D Plaza Sitara Market G-7 Markaz, Islamabad

07. Mr. Nasir Mehmood Dar Sir Syed Deaf Association12-D, SNC Suite # 5+6 Fazl-e- Haq, Blue Area,Islamabad

08. Mr. Sohail Farooq Sir Syed Deaf Association12-D, SNC Centre Suite # 5+6 Fazl-e- Haq, BlueArea, Islamabad

09. Dr. Fayaz Ahmed Bhatti V.R.E.D.P Directorate General of Special Education,Islamabad

10. Mr. Sultan MehmoodMirza

Govt. Qandeel Secondary School for the BlindKohati Bazar, Rawalpindi

11. Dr. Maryam Mallick WHOWHO Office Park Road NIH Chak Shahzad,Islamabad

12. Mrs. Gulnaz Sultana Umeed-e- NoorF 8/3 House # 7 St. # 72 Islamabad

13. Dr. Imam Yar Baig Hashoo Foundation, Islamabad

14. Mrs. Naeema BushraMalik

National Institute of Special EducationPlot # 74 H- 8-4, Islamabad

15. Mrs. Naila Iqbal National Special Education Centre for MentallyRetarded ChildrenSt # 7, H-8/4. Opposite Alcatel Islamabad

16. Miss Hafsa Zarrar Sipra National Special Education Centre for MentallyRetarded ChildrenSt # 7, House 814 Islamabad

17. Mrs. Shahida Mumtaz Special EducationNational Special Education Centre for (HIC)IslamabadH-9 Plot # 27, Islamabad

18. Dr. Shabbir Hussain Hashoo Foundation (Umeed-e- Noor)House # 7-A Street 65 F-8/3 Islamabad

19. Dr. Ahmed Hassan Hassan Academy Special EducationMeharabad, Peshawar Road Rawalpindi

20. Mrs. Naghmana Jabeen D.G.S.E Min of Special EducationAl- Makhdoom S.E.C for V.H.C G-7/2, Islamabad

21. Miss. Misbah Kausar Al- Farabi S.E. C for P.H.C Islamabad

22. Mr. Haroon Ur- Rasheed REDOREDO Medical Complex I Murree Road Rawalpindi

23. Capt.( R) MaqboolAhmed

Pakistan Foundation Fighting Blindness & RawalpindiEye Donors OrganizationRamzan Plaza g-9 Markaz IslamabadREDO Behind Naz Cinema Murree Road Rawalpindi

24. Mr.Muhammad IlyasAyoub

Azad Kashmir Association of the Blind / AKABSchool for the Blind MirpurFlat # 4 Shehzad Plaza Opposite Pilot Boys HighSchool # 2Mirpur AJK

25. Miss Basharat Zaman Azad Kashmir Association for the BlindFlat # 4, Shehzad Plaza Opposite Pilot High School forBoys Mirpur AJK

26. Mr. Muhammad Akhtar Sir Syed Academy (Special Education) RawalpindiCantt

27. Mr. Muhammad AbbasAyoub

Azad Kashmir Association of the BlindFlat # 4 Shehzad Plaza Opposite Boys Piolot HighSchool # 2 Mirpur AJK

28. Mr. Hakim Din Ministry of Social Welfare Islamabad

29. Mr. Khalid Naeem DG, Directorate General of Special EducationOpposite Noori Hospital, Islamabad

ORGANISORS

30. Gul Najam Jamy Programme Manager, CSP, Aga Khan Foundation(Pakistan), Islamabad




Annexure IXREFERENCES

1 Report on National Census of Pakistan, 1998; Population Census Organization,Government of Pakistan.

2 National Policy for the Persons with Disabilities, 2002; Directorate General ofSpecial Education, Government of Pakistan.

3 National Plan of Action for the Persons with Disabilities, 2006; Directorate General ofSpecial Education, Government of Pakistan.

4 Survey of Facilities and Services for Persons with Disabilities, 2006; DirectorateGeneral of Special Education, Government of Pakistan.

5 The Accessibility Code of Pakistan, 2006; Directorate General of Special Education,Government of Pakistan.

6 Design Manual and Guidelines for Accessibility, 2007; Directorate General of SpecialEducation, Government of Pakistan.

7 People with Disabilities in India: From Commitments to Outcomes, May 2007;World Bank.

8 Training Manual to promote “Barrier Free Environment”; Rehabilitation Council ofIndia.

9 Study of the Educational Environments for Students with Physical Disabilities inGeneral Education, October,2003; Ghulam Nabi Shakir (submitted in partial fulfilmentof the requirements for the Degree of Doctor of Philosophy in Education at the Instituteof Education and Research, University of the Punjab, Lahore), Pakistan.

10 Towards Equalizing Opportunities for Disabled People in Asia: A Guide;International Labour Organization (ILO).

11 Pakistan Country Profile on Disability, March, 2002; Japan International CooperationAgency (JICA), Islamabad, Pakistan.

12 Situation Analysis and Plan of Action, 2004; m/s Arjumand Associates, Islamabad,Pakistan.

13 From Exclusion to Equality: Realizing the Rights of People with Disabilities –Handbook for Parliamentarians on the Convention on the Rights of Persons withDisabilities and its Optional Protocol, 2007; United Nations.

14 The UN Convention on the Rights of Persons with Disabilities and it’s OptionalProtocol; 2007

15 International Classification of Functioning, Disability and Health (WHO/ WorldHealth Assembly); 2001

Network of Organisations Working for Persons with Disabilities, Pakistan(NOW-PD, Pakistan)

D-114, Block-5, Clifton, Karachi, 75600 Pakistan.Tel: 92-21-5865501, 5865502 Fax: 92-21-5865503

E-Mail: [email protected]: www.nowpdp.org

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