InAsia

A Survey of Disabilities in Afghanistan

May 13, 2020 The Asia Foundation
InAsia
A Survey of Disabilities in Afghanistan
Show Notes Transcript

A new survey by The Asia Foundation and the World Health Organization provides a wealth of much-needed new data, and some startling results.

We interview the Foundation's Director of Policy and Research Tabasum Akseer on how the survey data should be used to make policy and measure progress towards improving the health and well-being of disabled populations in Afghanistan.

Read Akseer's full blog: https://asiafoundation.org/2020/05/13/disability-survey-is-afghanistans-first-in-15-years/

John Rieger (00:00):

Welcome to InAsia. I'm John Reiger.

Tracie Yang (00:02):

And I'm Tracie Yang.

John Rieger (00:04):

Afghanistan, and this edition and a new survey from the Asia Foundation that looks at disabilities among the Afghan people.

Tracie Yang (00:10):

Perhaps, unsurprisingly after decades of war, political chaos and persistent widespread poverty, Afghanistan also has a high rate of disabilities. Roughly 80% of adults have some form of impairment.

John Rieger (00:24):

This is just one of the findings of the newly released model disability survey of Afghanistan. And the director of that survey, our colleague, Tabasum Akseer is here to tell us more about it. Tabasum, welcome.

Tabasum Akseer (00:36):

Hi John. Hi Tracie. Thank you both for having me today.

John Rieger (00:39):

So hy this survey at this time?

Tabasum Akseer (00:41):

That's a good question. A national disability survey has not been done in Afghanistan in 15 years. The previous one in 2005 was the national disability survey of Afghanistan and since then we haven't really had any updated information on the prevalence rate of disabilities. Beyond the national level data from 2005, we've never really had any regional data on the prevalence of disabilities. So this 2019 survey is really the first time that we're able to understand disabilities using a standard approach, both at the national and the regional levels. It's also the first time that we're seeing the use of child specific questions to determine disability among children in the country.

Tracie Yang (01:23):

What are some of the more interesting findings of the survey?

Tabasum Akseer (01:27):

Well, there's lots of interesting findings. So it's very difficult to just pick a few. The most important findings from the survey is the prevalence rates for adults it's around 80%. For severe disabilities, it's 14%. It also varies by region. So in central Highlands, we have the highest concentration of severe disabilities of almost one fourth. Whereas in Kabul province, we have the lowest of around eight to 9%. We also find that around half of Afghans don't use assistive devices, including glasses, walking sticks, or other devices that can make their lives so much more comfortable simply because they don't really know about them.

John Rieger (02:08):

Are you saying that some of the people in Afghanistan don't know about eyeglasses?

Tabasum Akseer (02:13):

Correct. That's what our data is telling us. It's really interesting. We had to adapt the MDS because some of the questions were simply like out of context, it had questions about wheelchairs and ramps and we're like in Afghanistan, it's a country that is so desperate that it doesn't mean anything for them.

John Rieger (02:33):

So your survey found that 80% of adults in Afghanistan suffer from some kind of disability and that half of them don't use any assistive devices because they haven't heard of them?

Tabasum Akseer (02:43):

Correct.

John Rieger (02:45):

So is there any good news in the survey?

Tabasum Akseer (02:47):

Well it depends. The data tells us that since 2005, the situation has definitely gotten worse. The good news is that with this survey, we can actually identify where the needs and gaps are. And this is why earlier, when I talked about the regional data, we can use that data to provide effective targeting and pinpoint exactly what the needs of certain populations across the country are. The other good news is that because the survey is also nationally and regionally representative of children, we can also identify kids' needs as well. And luckily with kids, the severe disability rate is really low. It's only 3.5%. So this means that there's certainly lots of room to intervene for both the Afghan government and for the donor community when it comes to children's needs.

Tracie Yang (03:38):

Can you tell us a bit more about the MDS survey instrument?

Tabasum Akseer (03:42):

Sure. The model disability survey tool, it's a standardized tool or a general population survey that's designed to provide reliable and detailed data on all aspects of disability. This includes impairments, activity, limitations, participation restrictions, and so on related both health and environmental factors. What stands out really about this instrument is that unlike others, it looks at disability as an outcome of the dynamic of relationships, including the interactions between an individual with a health condition and various environmental and personal factors, rather than focusing only on a person's health or impairments. So as a result, the MDS gives us a holistic view of the experiences of an individual that disability and not just focusing on allowing that disability to define individuals.

John Rieger (04:34):

If such a high proportion of the Afghan population has a disability, does that mean that disabilities are on display everywhere in Afghan daily life or do they tend to be hidden?

Tabasum Akseer (04:44):

Well, keep in mind that while roughly 80% of Afghans do have a disability, not all Afghans have a physical or visibly noticeable disability, the most common types of disabilities that Afghans report to us are mostly related to back pain, anxiety, depression, blindness there are lower amount around 4%, then sight, loss of limbs. So going back to the question, are these disabilities visible or not? Yes or no. Then we get into the social stigmas. Not only of living with a disability in the public space, but also in the private space. When we look at, for example, women with disabilities, we find that a disproportionate number of them are separated or divorced. And this really speaks to the stigma that Afghans experience.

Tracie Yang (05:31):

So because there's a stigma, do your enumerators find it difficult to get accurate data?

Tabasum Akseer (05:39):

Well, I mean, the answer to the question is that getting that information out of them is sort of a part of 167 other questions that are all very similar to one another. The questions are very generally worded and it's later analyzed to help us determine the presence and severity of a disability. So each question or each response to the question adds up and it helps us create a combined score for each individual.

John Rieger (06:06):

This is fascinating.

Tabasum Akseer (06:07):

It's really interesting. And this is why it's the survey is so important because it has... There's such a wealth of data contained in it. We interviewed 14,290 households. Within those households, we interviewed three individuals, one the head of household. The second individual was a randomly selected adult. And the third individual was a child over, under the age of 17. The number of individuals that this data set represents is over 111,000 across the country. So that just speaks to the level of richness that this data set contains. There's questions about all aspects of life, not just limited to the disability or to access to healthcare, but their integration in the community, their schooling, things like that. There's, and this is why the data could be so valuable to both the Afghan government and also the international community is because it's just so wide ranging.

John Rieger (07:05):

So amidst Afghanistan, sea of troubles, is there any room here for some policy prescriptions?

Tabasum Akseer (07:10):

Yeah, absolutely. We do include some recommendations in the report for both the Afghan government and the donor community to use of nationwide campaigns to encourage awareness, education de-stigmatization and acceptance of disabilities, non-institutions is really essential. These are institutions, including the healthcare sector, education, government and the private sector. We're also encouraging both the government and the international community to use this dataset and implement evidence-based interventions or innovations that can target the most common health care challenges experienced by those with severe disabilities. And this is why the data set the regional representation is really important because what works in or what's required in central Highlands is very different than what's required in Kabul province. So using this data to customize a targeted approach is really, really going to help.

John Rieger (08:10):

We're going to have a huge click-through rate on this podcast among the numbers geeks.

Tabasum Akseer (08:14):

That's right. That's my jam. That's what I really like.

John Rieger (08:18):

Tabasum, you're really terrific. And it's really great to talk to you. I'm so glad you could be with us.

Tabasum Akseer (08:22):

I really appreciate you guys. Being so interested in this data and helping us kind of get the word out about it.

John Rieger (08:28):

You can read more about the model disability survey of Afghanistan and linked to the survey itself in this week's in Asia blog. I'm John Rieger.

Tracie Yang (08:36):

And I'm Tracie Yang.

John Rieger (08:38):

Thanks for listening.