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See Me, and Do Not Forget Me People with Disabilities in Kenya

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See Me, and Do Not Forget Me People with Disabilities in Kenya 1 See me, and do not forget me People with disabilities in Kenya Benedicte Ingstad Lisbet Grut SINTEF Health Research Oslo, Norway February 2007 2 Map of Kenya (http://en.wikipedia.org/wiki/Image:Kenya, 2006) 3 TABLE OF CONTENTS 1 Background ........................................................................................................................ 6 1.1 The contributors to the study...................................................................................... 6 1.2 Country background................................................................................................... 7 1.3 Kenya and disability issues ...................................................................................... 11 1.3.1 Post independent initiatives.............................................................................. 12 1.3.2 Issues of critical concern.................................................................................. 13 1.3.3 Disability, a cross cutting issue........................................................................ 14 1.3.4 Barriers............................................................................................................. 14 1.3.5 Disability and development.............................................................................. 15 1.3.6 Key achievements on issues of persons with disabilities................................. 15 2 The study of disability and poverty.................................................................................. 18 2.1 The Problem ............................................................................................................. 18 2.2 Understanding disability in the context of poverty .................................................. 18 2.2.1 Disability as limitation of functioning and participation ................................. 18 2.2.2 Poverty - a multidimensional concept.............................................................. 19 2.2.3 The relationship between disability and poverty.............................................. 20 2.3 Understanding disability within the context of social barriers................................. 22 2.3.1 The concept of Social Suffering....................................................................... 22 2.3.2 The household as a resource system ................................................................ 23 3 Methodology .................................................................................................................... 24 3.1 A Qualitative approach............................................................................................. 24 3.2 The interview guide.................................................................................................. 25 3.3 Ethical considerations in qualitative studies ............................................................ 25 3.4 The importance of choosing the right place to interview......................................... 26 3.5 The Districts visited for the field work .................................................................... 27 3.6 The sample ............................................................................................................... 27 3.7 Limitation of method and sample............................................................................. 29 4 How poverty generates disability..................................................................................... 31 4.1 Health factors ........................................................................................................... 31 4.2 Genetic and congenital conditions ........................................................................... 31 4.3 Conditions occurring in pregnancy and during birth ............................................... 32 4.4 Illnesses occurring later in life ................................................................................. 32 4.5 Accidents.................................................................................................................. 34 4.6 Environmental conditions ........................................................................................ 34 4.7 Access to health care................................................................................................ 35 4.8 Assistive devices ...................................................................................................... 36 4.9 Traditional medicine ................................................................................................ 37 4.10 Access to education.................................................................................................. 37 4.11 Families overwhelmed – give up ............................................................................. 38 5 How disability generates poverty..................................................................................... 40 5.1 Access to education, employment and resources..................................................... 40 5.2 Gender issues and vulnerability ............................................................................... 42 5.3 Lack of ownership and inheritance to land and livestock ........................................ 43 5.4 Fear of rape............................................................................................................... 45 5.5 Being left by the child’s father................................................................................. 46 5.6 Coping with disability in the context of poverty...................................................... 47 4 5.7 The supportive family .............................................................................................. 47 5.8 Education and work.................................................................................................. 48 5.9 Religion as a factor of resilience.............................................................................. 49 5.10 Sponsorship and fellow support ............................................................................... 50 6 Concluding remarks and recommendations ..................................................................... 51 6.1 The complexity of the situation for people with disabilities.................................... 51 6.2 The vulnerability of the independent individual ...................................................... 51 6.3 Lack of adapted services and counselling................................................................ 52 6.4 The need for affirmative actions .............................................................................. 53 6.5 Education and Employment ..................................................................................... 53 6.6 Suggestions for policy and programmes .................................................................. 53 6.7 Knowledge and Research......................................................................................... 54 References ................................................................................................................................ 56 Appendix I Districts visited...................................................................................................... 58 Appendix II The Interview guide............................................................................................ 60 Appendix III Manual on qualitative methodology.................................................................. 63 5 Abbreviations APDK - Association of Physically Disabled in Kenya CBR - Community Based Rehabilitation DPO - Disabled People’s Organisation EARS - Educational Assessment and Resource Services ICF - International Classification of Functioning KDHS - Kenya Demographic and health Survey KNAD - Kenya National Association of the Deaf KSPH - Kenya Society of the Physically Handicapped KUB - Kenya Union of the Blind MDG - Millennium Development Goals NCPWD - National Council for People with Disabilities NGO - Non Governmental Organisation PWD - People with disabilities SDO - Social Development Officers TB - Tuberculosis UDPK - The United Disabled Persons of Kenya UN - United Nations UNESCO - United Nations Educational, Scientific and Cultural Organization WHO - World Health Organisation 6 1 Background The WHO estimates that about six hundred million people live with disabilities of various types in the world, and the number is increasing due to the rise of chronic diseases, injuries, car crashes, falls, violence and other causes such as ageing. Of this total, 80% live in low- income countries; most are poor and have limited or no access to basic services, including rehabilitation facilities. (www.who.int Oct. 2006) Kenya acknowledges disability as a phenomenon that cuts across all spheres of society and which requires support from all sectors. Despite the lack of accurate data on the number of Persons with Disabilities in Kenya, it is noted that persons with disabilities are not a homogeneous group but are varied in terms of the nature of their disability and their mental, physical and social needs. Persons with disability in Kenya represent a critical segment. Like in most developing countries people with disabilities in Kenya are a marginalised population and face problems as a result of their disability. Most have no access to education, health, employment or rehabilitation. Despite the absence of accurate data, the Government and other stakeholders have continued to offer a wide range
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