|Year : 2020 | Volume
| Issue : 1 | Page : 50-54
What explains the wide variation in the prevalence of benchmark disability in the state of Andhra Pradesh?
Hareesh Angothu1, Chandra Banu Gupta Paritala2, Vijaychandra Reddy Avula3, Nageswara Rao Nallapaneni4
1 Associate Professor, Department of Psychiatry, NIMHANS, Bengaluru, Karnataka, India
2 Professor, Department of Psychiatry, Institute of Mental Health, Hyderabad, Telangana, India
3 Additional Professor of Psychiatry, Department of Psychiatry, AIIMS, Mangalagiri, Andhra Pradesh, India
4 Professor, Department of Psychiatry, SV Medical College, Tirupati, Andhra Pradesh, India
|Date of Submission||22-May-2020|
|Date of Decision||23-May-2020|
|Date of Acceptance||03-Jun-2020|
|Date of Web Publication||03-Jul-2020|
Dr. Hareesh Angothu
Department of Psychiatry, NIMHANS, Bengaluru, Karnataka
Source of Support: None, Conflict of Interest: None
Introduction: Population-based enumeration of persons with disability (PWD) is vital for the allocation of resources to provide social welfare measures, toward PWD inclusion, and for the improvement of their quality of life. Wide variations exist between different estimations of PWD across studies conducted by various agencies such as the Census Board of India, World Health Organization and World Bank. Irrespective of Population based estimations, In India, people certified as having 40% or above disability described as “BenchMark Disability”(BMD), are only eligible for social welfare measures like disability pension, job reservations intended for persons with disability.
Objectives: This study was carried out to understand if populations-based estimation of disability prevalence is equivalent to the prevalence of BMD or not.
Methodology: Data on the number of persons with BMD, published by the Social welfare department of Andhra Pradesh at online portal called SADAREM is compared to population-based estimation of number of PWD in Andhra Pradesh through census board estimation.
Results: As per census 2011, about 1,265,167 (2.5%) persons among the general population were estimated to have one or other disability in Andhra Pradesh State. The data published by the Social Welfare Department of AP state indicates a lower estimate, that by April 2020, there are only 957,412 (1.8%) persons among the general population had one or another BMD. In this article, the possible reasons for such variation are discussed as such variation may have significant policy level implications.
Keywords: Benchmark disability, person with disability, prevalence, SADAREM
|How to cite this article:|
Angothu H, Gupta Paritala CB, Avula VR, Nallapaneni NR. What explains the wide variation in the prevalence of benchmark disability in the state of Andhra Pradesh?. Arch Ment Health 2020;21:50-4
|How to cite this URL:|
Angothu H, Gupta Paritala CB, Avula VR, Nallapaneni NR. What explains the wide variation in the prevalence of benchmark disability in the state of Andhra Pradesh?. Arch Ment Health [serial online] 2020 [cited 2020 Aug 10];21:50-4. Available from: http://www.amhonline.org/text.asp?2020/21/1/50/288916
| Introduction|| |
The World Health Organization in its world report on disability, recommended that there should be more investment by appropriate authorities in specific programs and services for persons with disability (PWD). Nearly 15.6% and 19.4% of the world population were estimated to have one or other disability as per the World Health Survey and the Global Burden of Disease study, respectively. PWD would have limitations in full participation on par with others due to a range of factors such as sensory and physical impairments, environmental barriers, and attitudinal barriers throughout their lifespan. Such limitations exist across a variety of settings such as education, employment, marriage, sports, social, recreation, and politics. The above-mentioned two large databases on PWD estimated that the prevalence of PWD having severe participation restrictions would be around 2%–3%. As the state is responsible for creating policies, systems, schemes, and programs for the inclusion of PWD in the mainstream society, different countries may adopt different approaches on defining the term severe disability, which would be a necessary minimum criterion for access to the welfare measures. An overview of such policies and comparison would be beyond the scope of this article. When we examined the data spent by few countries on social justice which broadly include the expenditure spent for the inclusion of PWD, developed countries had an expense of more than 20% gross domestic product (GDP) share, and African and Asian countries have <10% of GDP as a social expenditure. Austria, Finland, Belgium, Greece, and Italy appear to have allocation above 25% of their GDP, and the average amount of GDP allocation by the Organisation for Economic Co-operation and Development which has 37 countries as members is 20% during the year 2016.
An overview of the allocation of budget for the welfare of persons with disability in India
The Ministry of Social Justice and Empowerment (MOSJ is the organization under the Government of India [GOI]) develops policies, plans, schemes, and directives for the upliftment of vulnerable population such as marginalized groups including PWD. As the direct provision of social welfare measures falls under the respective state government to a more significant extent, budget allocation made by the GOI may not reflect the actual distribution for PWD social welfare measures. Nevertheless, the MOSJ funds many programs for the inclusion of PWD, and the fund allocation to the MOSJ by the GOI could be an indicator of the overall approach taken by the GOI toward the inclusion of PWD. According to a report published by the MOSJ, allocation of the budget under the GOI under welfare schemes for the PWD is 242 crores per year during 2008–2009. This corresponds to 0.03% of the total revenue expenditure GDP by the GOI for the year 2008–2009. After carving out a separate department called the Department of Empowerment of PWD (DEPWD) under the MOSJ, there is an increase in the budget allocation to this sector. While the total budget allocation was around 944 crores for the financial year (FY) 2017–2018, it increased to 1144 crores to the DEPWD for the FY 2019–2020. However, this corresponds to 0.04% of the total estimated budget amount of 2,786,349 crores for the FY 2019–2010 under the GOI. However, this may be an underrepresentation of the overall amount spent for the welfare of PWD as PWD welfare schemes and expenditure are mainly under the state governments where the PWD resides. Nevertheless, the budget allocated for the welfare and inclusion in low- and middle-income countries is less compared to that of the Organization and Economic Co-operation for the Development (OECD) countries, and Indian policymakers should reconsider such allocations to improve overall participation and quality of life of PWD.
Eligibility for social welfare benefits in India across the states
As per the guidelines released from time to time by the MOSJ about the conditions which may cause disability, and the process of measurement of disability, a cutoff has been created for PWD to be eligible to access social welfare schemes under the term “BenchMark Disability” (BMD). Section 2 of the Rights of Persons with Disabilities (RPwD) Act 2016, defines a person with BMD as a person with not less than 40% of a specified disability, where specified disability has not been defined in measurable terms and includes a person with disability where specified disability has been defined in measurable terms, as certified by the certifying authority as per the RPWD Act 2016. Only those who would be certified as having a BMD would be eligible for any kind of social welfare programs or scheme intended for PWD.
To our knowledge there are published literature on the number of persons with BMD in India. We could not come across any data base or study in this regard. A new initiative under the DEPWD is the creation of unique disability identification or Swavalamban card for persons with BMD, and it is still under process without any published national data on persons with BMD. Considering this, we have explored the data, which are published online and are freely accessible to all, about the persons with BMD. As Andhra Pradesh (AP) maintains such data on a platform called SADAREM under each of the 13 districts and updates persons with BMD data on a day-to-day basis, SADAREM database is considered for our study and secondary analysis.
| Data Collection Method|| |
Secondary analysis of the data published by the SADAREM database on May 9, 2020, a blind date, was considered for this analysis, as these data are likely to change in numbers on a day-to-day basis by the new certifications or due to the death of persons with BMD.
| Results|| |
Data about the persons with BMD were downloaded from the available information from the SADAREM online database in Microsoft Excel format, and analysis was carried out for descriptive statistics. These data represent a cumulative number of persons with BMD irrespective of the cause of the disability.
As per the data in [Table 1], while about 12.65 lakhs were estimated to have one or other disability in the state of AP as per census 2011, data published by the Society for the Elimination of Poverty under the Government of AP through the SADAREM indicate that persons with BMD are <1 million by April 2020.
|Table 1: Comparison of the number of estimated persons with disability in 2011 to the number of persons with benchmark disability in 2020|
Click here to view
Data shown in [Table 2] depict that there is an estimated general population of 52 million in AP state by April 2020, in comparison to census 2011 estimation of the general population of 49 million for all the 13 districts which were mentioned here. [Table 1] and [Table 2] indicate a population increase of about three million from 2011 to 2020. However, the number of persons with BMD by April 2020 in this state is about 20% less than the estimated PWD in the year 2011.
|Table 2: Persons with disability as per census 2011 and persons with benchmark disability 2020 conversion into percentages|
Click here to view
| Discussion|| |
A large reduction is observed between the estimated number of PWD in the year 2011 in AP State to the estimated number of persons with BMD by April 2020. For policymakers and administrators, at a population level for resource allocations, a reduction from 2.56% of the general population having one or other severe disability by 2011, to 1.8% of the general population having a disability by April 2020 may appear as a more significant achievement., However, these data need to be interpreted cautiously. The reduction in the percentage of the general population eligible for state-funded social welfare schemes from PWD estimation could be due to a range of factors. A finding from [Table 1] indicates that while 1.5% of the general population had BMD in the district of Visakhapatnam, 2.2% of persons had BMD in its adjacent district Vijayanagaram. Such variations, even in neighboring districts within a state, would suggest the need for more caution in interpreting these findings. Based on our expertise and understanding of the certification process for BMD, we attempt to list a few possible explanations for such variation and reduction in PWD eligible for state social welfare benefits.
- A simple explanation could be that PWD estimation in the year 2011 was by questionnaire administration by field staff during a household survey, and the responses were based on the subjective assessments in comparison to persons with BMD who would be assessed by qualified medical professionals during medical board examination by following a set of uniform guidelines issued by the MOSJ, GOI
- However, the above one could be too simplistic and may fail to address many other complex issues which may play a significant role in this process. Assessment of BMD and certification happens at a tertiary care hospital medical board, and a substantial number of people with no access or limited access to such assessment would be excluded in contrast to the census 2011, in which PWD enumeration was based on a household survey
- The SADAREM online portal also publishes the data on the number of persons who have a disability <40% after assessment by the respective medical boards, and it suggests that there are about 180,000 individuals who would fall under this who may have been calculated as PWD 
- A significant number of PWD who were described as having <40% BMD and who may fall in the 30–40 category may move to an eligible category based on differences in interrater reliability as these measurements are subjective
- Assessment of BMD is usually a one-time procedure; a range of patient-related or clinician-related factors could influence the outcome of such evaluations
- Persons living in remote areas with sensory and physical impairments may have access to barriers especially if they are from below poverty line and/or had no family member to support
- Due to the shortage of an available number of specialists under state government service for this kind of BMD assessments, often, the state invites specialist on a need basis with payment for services provided by such specialist doctors. During such periods, a camp-based approach would be used wherein a particular number of people like 30–80 persons have to be assessed in a single day. Such a camp-based assessment could affect the quality of the evaluation and could influence the outcome in numbers
- PWD confined to state-run shelter homes or nongovernment organization-run homes, or homeless wandering PWD, and wandering persons with mental illness or intellectual disability with no family to support, often would not get access to this kind of assessments conducted at tertiary care hospitals
- Natural changes in the population over a decade which could involve migration, new births, deaths of the vulnerable population, reduction of some diseases due to advances in health care, and reduction in barriers to treatment leading to early intervention, thus reducing the impact of the disease
- The existing system for the assessment of BMD is that a person has to apply through the Internet by submitting all necessary identification documents to get an appointment for such assessment. A significant number of people who may not have such identification documents and who may not have access to digital services could face barriers even before the assessment.
| Conclusions|| |
As per the data published by the State Government of AP, there is a reduction of the prevalence of persons with a disability, with a quantum of disability described as BMD (40% or above) to 1.8% by April 2020, in comparison to the estimated 2.56% during population census 2011. Such reduction at population level indicates higher numbers. As discussed in this article, there are only < 1 million persons with BMD, in comparison to 1.2 million PWD. Such a considerable reduction in number could reduce the quantum of money needs to be spent toward social justice and empowerment of PWD, the reasons for which should be explored before making conclusions. A more proactive approach by the concerned social justice departments to reach PWD living in confinements or remote locations, PWD having no identification documents, and homeless PWD should be considered for the goal of inclusion of all.
A periodic review of the systems and procedures for understanding any access to barriers with all stakeholders is mandatory to improve the reach of state welfare benefits to the needy. Medical professionals and social work professionals have to focus on researching this area to explore the possible reasons in this regard.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
MOSJ, GOI. Year End Review 2018: Department of Empowerment of Persons with Disabilities (DEPwD) under M/O Social Justice & Empowerment. Press Release Information Bureau; 2018. Available from: https://pib.gov.in/PressReleseDetail.aspx?PRID=1555977. [Last accessed on 2020 Apr 30].
SERP. Government of Andhra Pradesh. Software for Assessment of Disabled for Access Rehabilitation and Empowerment. Database. Available from: https://sadarem.ap.gov.in/SADAREM/.
[Last accessed on 2020 May 09].
[Table 1], [Table 2]