MODEL THE WORLD BAN SUR

MODEL SURVEY GENERAL RESULTS DISTRICT, PROVINCE,

Table of Contents

1 Introduction ...... 2 1.1 How does the MDS measure disability? ...... 2 1.2 What were the objectives of the implementation in Baluchistan? ...... 3 2 Core results ...... 4 2.1 Households ...... 4 2.2 Demographic characteristics ...... 5 2.3 Disability ...... 6 2.4 Most affected daily life areas ...... 8 2.5 Health ...... 22 2.6 Work ...... 24 2.7 Education ...... 25 2.8 Environmental factors ...... 26 2.9 Health care responsiveness ...... 33 2.10 Well-Being ...... 35

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1 Introduction

The Model Disability Survey (MDS) is a survey questionnaire used to collect data about disability in a country or country region. The MDS was developed by the World Health Organization (WHO) and the World Bank in 2012, in consultation with international organisations, leading researchers, and DPOs. The survey helps countries authorities, NGOs and DPOs better understand the situation of people who have disability, especially their unmet needs as well as the barriers that they face in daily life. Governments use the data to develop disability policies and national or regional disability action plans that are based on the real-life situation of people who have disability. They also use the data to monitor and report on the implementation of the Convention on the Rights of Persons with and the indicators of the Sustainable Development Goals. NGOs and DPOs use the data to advocate for what is needed to ensure that people who have disability can enjoy their human rights fully on an equal basis with others. 1.1 How does the MDS measure disability? The MDS takes a broad approach by measuring disability taking into account health conditions (e.g. depression or diabetes) or impairments (e.g. vision or ) people have and the context in which they live. The context includes: - Barriers faced in the community, for instance being able to access public spaces; - Attitudes of others, for instance being treated with respect or considered able to work; - Social support received, for instance having family or friends one can count on; - Easiness of access to health care, for instance being able to see a family doctor; - Easiness of access to assistive products of good quality, such as a cane or wheelchair; - Laws in place that ensure rights, such the right to receive an education in regular schools.

As a result of the interaction between health conditions or impairments and the context in which a person lives, disability might be faced in daily life, including:

- impairments, such as pain, loss of cardiovascular function or loss of muscle power; - limitations in activities, such as moving around in the neighbourhood, eating or to tidying up oneself, and restrictions in participation in society, such as problems to work or to participate on community activities.

The MDS approach also understands disability as a continuum that ranges from no disability to very high levels of disability, depending on the health conditions and the context of the person. Disability is a matter of degree, and no, mild, moderate or severe levels of disability can be differentiated for policy purposes.

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The level of disability in countries and regions is influenced therefore not only by trends in health conditions and impairments but also by physical, human-built, attitudinal and socio- political barriers or facilitators. Natural disasters, such as long drought periods, conflict situations, such as war, or the number of traffic accidents, will affect disability levels in a population both by changing the prevalence of impairments and by creating physical barriers. 1.2 What were the objectives of the implementation in Baluchistan? Pakistan faces several challenges that are frequently associated with high levels of disability, such as a high prevalence of , insufficient maternal health care, problems with health care accessibility, chronic poverty, frequent natural disasters, and ongoing war on terror. Additionally, persons with severe impairments, such as paralysis or amputations, face overwhelming barriers in all aspects of life including education, livelihood, health care and skills development, and there is a lack of adequate legislation, policies and programming for persons with disability in Pakistan. The Taraqee Foundation is a non-governmental and non-profit national level organization working in Pakistan since 1994. It has implemented several small and large scale projects to assist marginalized communities in far flung areas of Baluchistan and other provinces of Pakistan. The Taraqee Foundation has vast experience of working on disability in the province and specifically in the district Ziarat, where has had a partnership with the Pakistan Poverty Alleviation Fund in the scope of disability interventions for the last decade. The Taraqee Foundation supported a regional implementation of the MDS in the district Ziarat of Baluchistan to estimate how many people have severe, moderate and mild disability, and to identify the unmet needs as well as the barriers and inequalities faced by these persons in daily life. The data should be used to better plan services and policies for persons with disability and to advocate for a national data collection in Pakistan. Therefore, the objectives of the MDS in the Ziarat District, Balochistan, Pakistan are: 1. To estimate the prevalence of disability; 2. To determine the current disability distribution of the population; 3. To identify needs, barriers and inequalities faced by persons with different levels of disability; 4. To provide the information necessary for the development of future policy priorities to improve the lives of the population with disability in the Ziarat District. The sample size was extimated using the sample size determination formula for Lorenz's cross-sectional studies and a total minimum of 545 individual participants was set as the target sample.

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2 Core results

2.1 Households

The mean, median and range of the number of people living in the 450 participating households by age category are given in Table 1.

Table 1: Basic statistics of the number of people living in each household by age category

Age group Mean (SD) Median Range Children up to 5 0.7622 (0.99) 0 0 - 4 Children between 5 and 18 2.331 (2.15) 2 0 - 12 Adults between 19-40 years old 2.596 (1.83) 2 0 - 11 Adults between 41-60 years old 0.8711 (0.84) 1 0 - 7 Adults older than 60 years old 0.5067 (0.69) 0 0 - 3 Total persons living in the household 7.067 (2.75) 7 2 - 15

The age and gender distribution of the people living in the selected households is visualized in Figure 1.

Figure 1: Age and gender distribution of the of the people living in the selected households.

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2.2 Demographic characteristics

The demographic characteristics of the sample of 450 individuals living in the Ziarat District are given in Table 2. The sample included 300 men and 150 women. While women were balanced distributed regarding age, the large majority of men (62.5%) were aged 18 to 39 years old. While almost all men were working (89%), the large majority of women didn’t work for pay (78%). The percentage of persons without any education in mucher higher in women (82%) than in men (22.3%). Given the large sex differences in the sample, results will be presented separately for men and women.

Table 2: Demographic characteristics of the sample.

Total sample Men Women Characteristic N % N % N % Age group (years) 18-39 233 52.5 185 62.5 48 32.4 40-59 139 31.3 84 28.4 55 37.2 >60 72 16.2 27 9.1 45 30.4 Total 444 100% 296 100% 148 100% Work status Not working 150 33.3 33 11 117 78 Working 300 66.7 267 89 33 22 Total 450 100% 300 100% 150 100% Education level No education 190 42.2 67 22.3 123 82 Elementary 17 3.8 16 5.3 1 0.7 Vocational 41 9.1 34 11.3 7 4.7 Secondary 122 27.1 117 39 5 3.3 Higher 76 16.9 64 21.3 12 8 Other 4 0.9 2 0.7 2 1.3 Total 450 100% 300 100% 150 100% Marital status Single 83 18.4 72 24 11 7.3 Married or legal 318 70.7 227 75.7 91 60.7 cohabitation Widowed 49 10.9 1 0.3 48 32 Total 450 100% 300 100% 150 100%

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2.3 Disability

Disability is the outcome of the interaction between health conditions or impairments and features of the physical, human-built, attitudinal and socio-political environment in which the person lives. Disability is also understood in the survey as a continuum, ranging from very low to severe levels of disability.

Figure 2 shows the continuum of disability in Ziarat, in a metrical scale ranging from low levels of disability (zero) to very high levels (100). This figure shows that the majority of the sample experience moderate disability. However, important sex differences are observed in Figure 3: while the proportion of men with severe disability levels (dark blue) is very small in the distribution for males, it is very high for females. Results presented in Table 3 corroborate these observations.

Figure 2: Disability continuum for the Ziarat District

Figure 3: Disability continuum for the Ziarat district by sex

Men (N=300) Women (N=150)

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Table 3 shows the proportions of the sample with mild, moderate and severe disability, for the total sample and by sex. Results are dramatically different for men and women. The severe disability rate is 16.2% for the complete sample, coming close to the 15% global estimate of WHO. However, wenn disagreggated by sex, the rate of severe disability is very low for men, 3.3%, and very high for women, 42%. While approximately 60% of men have no or mild disability levels, only approximately 5% of the women included in this sample have no or mild levels of disability. Indeed, the proportion of women with moderate or severe disability amounts to approximately 95%. Due to these very large differences, all results will be presented separately for men and women.

Table 3: Absolute numbers and percentages of persons with no, mild, moderate and severe disability, by gender.

Total sample Men Women Disability level N % N % N % No disability 51 11.3 51 17 0 0 Mild disability 136 30.2 128 42.7 8 5.3 Moderate disability 190 42.2 111 37 79 52.7 Severe disability 73 16.2 10 3.3 63 42 Total 450 100% 300 100% 150 100%

Table 4 shows the demographic characteristics of men and women by disability level.

Only 10 men (3.3%) had severe disability. This must be taken into account when interpreting results of this implementation. Comparing the 37% of men with moderate disability to the men with no to mild disability, we observe: - No age-associated differences between the groups; - The higher the disability level, the higher the proportion of males not working; - That males with severe disability have lower educational outcomes.

Only eight women (5.3%) had mild disability and no one had no disability. Comparing the 42% of women with severe disability to the 52.7% with moderate disability, we observe that: - Women with severe disability are older and more frequently widows; - More women with severe disability do not work, but differences are not large; - No differences regarding education.

Table 4: Demographic characteristics by disability level for men and women. No women had no disability.

Men (N=300) Women (N=150) Disability level Disability level Characteristic No Mild Moderate Severe Mild Moderate Severe N % N % N % N % N % N % N % Age (years) 17-39 40 78.4 83 65.9 58 53.2 4 40 6 85.7 34 43.6 8 12.7 40-59 9 17.6 35 27.8 37 33.9 3 30 0 0 29 37.2 26 41.3 >60 2 3.9 8 6.3 14 12.8 3 30 1 14.3 15 19.2 29 46 Work status

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Men (N=300) Women (N=150) Disability level Disability level Characteristic No Mild Moderate Severe Mild Moderate Severe N % N % N % N % N % N % N % Not working 1 2 11 8.6 15 13.5 6 60 4 50 58 73.4 55 87.3 Working 50 98 117 91.4 96 86.5 4 40 4 50 21 26.6 8 12.7 Education No education 10 19.6 24 18.8 29 26.1 4 40 3 37.5 65 82.3 55 87.3 Elementary 2 3.9 7 5.5 7 6.3 0 0 0 0 1 1.3 0 0 Vocational 5 9.8 9 7 18 16.2 2 20 0 0 4 5.1 3 4.8 Secondary 24 47.1 58 45.3 33 29.7 2 20 1 12.5 2 2.5 2 3.2 Higher 10 19.6 29 22.7 23 20.7 2 20 4 50 5 6.3 3 4.8 Other 0 0 1 0.8 1 0.9 0 0 0 0 2 2.5 0 0 Marital status Single 19 37.3 29 22.7 22 19.8 2 20 2 25 2 2.5 7 11.1 Married or legal 32 62.7 98 76.6 89 80.2 8 80 6 75 57 72.2 28 44.4 cohabitation Widowed 0 0 1 0.8 0 0 0 0 0 0 20 25.3 28 44.4

The general severe disability prevalence for Ziarat District is 16.2%. Extreme sex differences are observed: severe disability prevalence for Ziarat District is 3.3% in men and 42% in women.

2.4 Most affected daily life areas

In the MDS disability is estimated based on problems reported in 17 functioning domains: mobility, hand and arm use, self-care, seeing, hearing, pain, sleep and energy, breathing, affect, interpersonal relationships, handling stress, communication, cognition, household tasks, community and citizenship participation, caring for others and work and schooling.

Each domain is assessed with several questions covering different areas and presented in graphs in the next pages for men (blue graphs) and women (red graphs).

Extreme problems with mobility are presented in Figure 4 and are one of the most affected life areas both for men and women. Considering males, extreme problems are overwhelmingly reported by the men with severe disability. Considering females, although women with severe disability report considerable more frequently extreme problems, many mobility areas are very problematic for women with moderate disability.

Extreme problems with self-care are overwhelmenly reported by persons with severe disability (Figure 5) but also considerably affect women with moderate disability.

Extreme problems with seeing and hearing are shown in Figure 6. More women than men report extreme problems, except for hearing in a noisy room. Pain, sleep and lack of energy (tiredness) affect mostly men with severe disability (Figure 7) while in women, extreme problems with pain, sleep and lack of energy (tiredness) are observed across disability levels (Figure 7).

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Considerably more persons with severe levels of disability experience extreme problems with breathing: approximately 40% men and 36.5% of the women report extreme problems with coughing or wheezing (Figure 8).

Extreme problems with interpersonal relationships mostly affect women with moderate and severe disability (Figure 9) and the same pattern is observed for depressive and anxiety feelings (Figure 10).

Extreme problems with communication are relatively seldom and mostly reported by women with severe disability (Figure 11) while extreme problems with cognition are observed across disability levels overwhelmingly in women (Figure 12).

Regarding household tasks, managing money and providing care, mostly men and women with severe disability face extreme problems (Figure 13). The same pattern is observed for participation in society (Figure 14).

Men face extreme problems applying for and getting a job, independently of their level of disability, as do almost all women with moderate or severe disability (Figure 15).

The proportions of men facing extreme problems applying for and getting a job is very high and independent of the level of disability, ranging from 83% to 95% (Figure 15). Similarly, almost all women with moderate or severe disability face extreme problems applying for and getting a job (Figure 15). Regarding getting things done at work, the same pattern is observed for men and women: the higher the level of disability, the higher the proportion of persons facing problems (Figure 15).

Almost all persons with severe disability face extreme problems to get an education and to get things done at school (Figure 15).

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Mobility

Figure 4: Percentages of men (blue) and women (red) rating mobility domains as very problematic or extremely problematic, by disability level. 100 90 90 80 80 80 80 70 70 60 60 60 60 48.2 50 40 27.9 30 20.6 20 16.2 8.1 9.8 10 4.5 3.9 5.4 4.5 0 0.8 0 0 0 0.82.7 0 0 0 0 0.8 2 1.6 0 Standing up Standing for 30 Getting out of Walking 100m Walking 1 km Engaging in Getting where Using public or minutes your home vigorous you want to go private activities transportation

No Mild Moderate Severe

100 90 84.1 84.1 84 81 81 79.4 80 73 74.6 70 60 47 50 40.5 40 32.9 29.1 25 30 21.5 22.8 22.8 20 12.7 12.5 10 0 0 0 0 0 0 0 Standing up Standing for 30 Getting out of Walking 100m Walking 1 km Engaging in Getting where Using public or minutes your home vigorous you want to go private activities transportation

Mild Moderate Severe

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Self-care

Figure 5: Percentages of men (blue) and women (red) rating self-care aspects as very problematic or extremely problematic, by disability level.

100 90 80 80 70 70 60 60 60 50 40 30 20 20

10 3.6 3.6 0 0 0 0 0 0 0 0 0.9 0 0 0 0 0 Being clean and Eating Toileting Cutting your toenails Looking after your dressed health

No Mild Moderate Severe

100 90 77.8 80 76.2 70 60.3 60 54 50 41.3 40 30 26.6 17.7 19 20 10.1 10 6.3 0 0 0 0 0 0 Being clean and Eating Toileting Cutting your toenails Looking after your dressed health

Mild Moderate Severe

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Seeing and hearing

Figure 6: Percentages of men (blue) and women (red) rating seeing and hearing as very problematic or extremely problematic, by disability level. 100 90 80 70 60 50 40 40 30 30 20 20 10 9 10 6.4 5.5 0 1.6 0 0 0 0 0 2 1.6 0 Seeing at a distance Seeing at arm's length Hearing in a quiet room Hearing in a noisy room

No Mild Moderate Severe

100 90 80 70 60 50

40 33.3 34.9 30 27 25.4 20 7.6 8.9 7.6 10 3.8 0 0 0 0 0 Seeing at a distance Seeing at arm's length Hearing in a quiet room Hearing in a noisy room

Mild Moderate Severe

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Pain and daily life energy

Figure 7: Percentages of men (blue) and women (red) rating pain, sleep and feeling tired as very problematic or extremely problematic, by disability level. 100 90 80 70 60 60 50 50 40 40 30

20 12.6 7.2 9 10 5.9 3.9 0 0 0 0.8 0 Pain Sleep Feeling tired

No Mild Moderate Severe

100 90 80 70 63.5 58.7 60 50 46 40 36.7 27.8 30.4 30

20 12.5 12.5 10 0 0 Pain Sleep Feeling tired

Mild Moderate Severe

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Breathing

Figure 8: Percentages of men (blue) and women (red) rating breathing as very problematic or extremely problematic, by disability level. 100 90 80 70 60 50 40 40 30 20 10 10 2.7 0 0 0 0 1.8 0 Shortness of breath Coughing or wheezing

No Mild Moderate Severe

100 90 80 70 60 50 36.5 40 31.7 30 20 7.6 10 6.3 0 0 0 Shortness of breath Coughing or wheezing

Mild Moderate Severe

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Interpersonal relationships

Figure 9: Percentages of men (blue) and women (red) rating areas of interpersonal relationships as very problematic or extremely problematic, by disability level. 100 90 80 70 60 50 40 30 30

20 11.1 8.1 10 10 6.3 5.9 0 0.8 0.9 0 0 0.8 0 0.8 0 0 0 Getting along with people Dealing with people you do Initiating and maintaining Intimate relationships close to you not know friendships

No Mild Moderate Severe

100 90 80

70 61.3 60 47.6 45.7 50 41.2 40 30 19.2 21.1 20 16.9 16.9 10 0 0 0 0 0 Getting along with people Dealing with people you do Initiating and maintaining Intimate relationships close to you not know friendships

Mild Moderate Severe

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Handling stress and emotional functions

Figure 10: Percentages of men (blue) and women (red) rating handling stress and emotional functions as very problematic or extremely problematic, by disability level. 100 90 80 70 60 60 50 50 40 30 30 30 20 11.7 7.8 7.2 10 1.6 2 1.6 2.7 0 0.8 1.8 0 1.6 0 Handling stress Coping with all the things Feeling sad, low or Feeling worried or nervous you have to do depressed

No Mild Moderate Severe

100 90 84.1 79.4 80 74.6 70 66.7 65.8 60 46.8 50 44.3 39.2 40 30 25 25 20 12.5 12.5 10 0 Handling stress Coping with all the things Feeling sad, low or Feeling worried or nervous you have to do depressed

Mild Moderate Severe

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Communication

Figure 11: Percentages of men (blue) and women (red) rating communication as very problematic or extremely problematic, by disability level. 100 90 80 70 60 50 40 30 20 10 10 10 0 0 0 0 0 0.9 0 Being understood Understanding others

No Mild Moderate Severe

100

90

80

70

60

50

40 28.6 30 25.4

20 7.6 10 3.8 0 0 0 Being understood Understanding others

Mild Moderate Severe

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Cognition

Figure 12: Percentages of men (blue) and women (red) rating cognition areas as very problematic or extremely problematic, by disability level. 100 90 80 70 60 50 40 30 30 30 20 17.1 20 10 5.4 0 1.6 0 0 2.7 0 0.8 0 Forgetfulness Remembering to do important things in Finding solutions to day-to-day day-to-day life problems

No Mild Moderate Severe

100 90 77.8 77.8 80 76.2 70 60 55.7 48.1 50 37.5 39.2 40 30 25 25 20 10 0 Forgetfulness Remembering to do important things in Finding solutions to day-to-day day-to-day life problems

Mild Moderate Severe

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Handling household tasks

Figure 13: Percentages of men (blue) and women (red) rating household tasks, managing money and providing care areas as very problematic or extremely problematic, by disability level. 100 90 80 77.8 80 70 70 60 50 40 30 20.7 20 11.7 7 10 4.5 3.9 0 0.8 2 0.8 0 Household tasks Managing money you have Providing care to others

No Mild Moderate Severe

100

90 82.5 76.2 80 72.6 70 60 50 50.6 50 40 29.1 30 26.6

20 12.5 10 0 0 Household tasks Managing money you have Providing care to others

Mild Moderate Severe

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Participation in society

Figure 14: Percentages of men (blue) and women (red) rating participation areas as very problematic or extremely problematic, by disability level. 100 90 80 70 60 60 55.6 50 50 40 40 31.4 30

20 11.2 10 5.5 5.4 4.2 4.5 0 0.8 0 0 0 0 0 Doing things for relaxation Joining community activities Engaging in local or national Voting in last election or pleasure politics or civil society organizations

No Mild Moderate Severe

100 90 77.4 80 80 69 70 60 52.4 50 50 50 40 33.3 35.5 30 25 19 20 12.5 10 0 0 Doing things for relaxation Joining community activities Engaging in local or national Voting in last election or pleasure politics or civil society organizations

Mild Moderate Severe

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Work and Education

Figure 15: Percentages of men (blue) and women (red) rating work and education areas as very problematic or extremely problematic, by disability level. 100 100 94.4 95 89.5 90 83.3 80 70 60 50 50 44 38.7 35.6 40 31.4 30 18.8 20 14.3 6.8 10 4 0 0 Applying for and getting a job Getting things done at work Getting an education Getting things done at school

No Mild Moderate Severe

100 100 100 95 91.4 88.9 90 80 70 60 50 46.7 50 42.9 40 40 30 25 25

20 14.3 10 0 Applying for and getting a job Getting things done at work Getting an education Getting things done at school

Mild Moderate Severe

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2.5 Health

2.5.1 Health conditions and impairments

Figure 16 shows the prevalence of self-reported health conditions or impairments by disability level, for men (blue) and women (red).

The top most common self-reported health conditions or impairments for men are: - Severe disability: depression, hypertension, diabetes, arthritis/arthrosis, back pain, stroke, anxiety and skin diseases; - Moderate disability: depression, anxiety, vision loss, hypertension, kidney diseases; - Mild disability: vision loss, kidney diseases, anxiety, gastritis and hypertension.

The top most common self-reported health conditions or impairments for women are: - Severe disability: depression, back pain, hypertension, kidney diseases, vision loss, hearing loss, arthritis/arthrosis, heart diseases, diabetes; - Moderate disability: back pain, kidney diseases, hypertension, depression, vision loss, arthritis/arthrosis, hearing loss; - Mild disability: back pain, hypertension, kidney diseases, arthritis/arthrosis, diabetes, gastritis, migraine, asthma.

Important to note are the very high prevalences of depression, back pain, hypertension and kidney diseases across disability levels. All these prevalences are much higher in women than in men.

Figure 16: Self-reported health conditions or impairments, by disability level, for men (blue) and women (red).

100 90 80 70 60 50 40 40 37.8 30 30 27 30 26.1 18 20 20 20 20 20 18 20 14.4 10 10 910 10 10 10 10 10 10 8.1 5.4 10 3.6 4.5 3.6 1.8 2.7 2.7 4.5 0

Mild Moderate Severe

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100 90 80 70 65.1 57.1 60 49.2 50 45.6 44.4 39.2 35.4 38 38.1 40 23.8 30 37.5 24.1 23.8 24.1 22.2 20.6 12.51.3 3.8 20 11.4 4.812.5 1.6 1.6 8.9 9.5 4.8 1.6 10 5.1 5.1 3.2 0 12.5 12.5 0 0 12.5 0 12.5 0 02.5 02.5 0 01.3 0 01.6 01.3 12.5 0 0

Mild Moderate Severe

2.5.2 Capacity

Capacity, or health state, is defined as the synthesis of all intrinsic physical and mental capacities of a person, determined solely by his or her health conditions or impairments. A capacity score is estimated for every respondent based on difficulties in 17 functioning domains (module 5000).

Table 5 shows the proportions of the sample with mild, moderate and severe capacity difficulties. Estimates are very similar to the disability estimates and show that the impact of the environment is not facilitating but hindering.

Table 5: Distribution of sample by capacity level

Total sample Men Women Capacity level N Percentage* N Percentage* N Percentage* No difficulties 88 19.6 88 29.3 0 0 Mild difficulties 103 22.9 98 32.7 5 3.3 Moderate difficulties 188 41.8 104 34.7 84 56 Severe difficulties 71 15.8 10 3.3 61 40.7 Total 450 100% 300 100% 150 100% *Weighted percentage takes into account the sampling weight.

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2.6 Work

Approximately 28% of the men with severe disability are not working, compared to 0.8% of the men with mild disability, and the higher the disability level, the lower the rates of men working for wages (Figure 17).

Approximately 70% of the women with severe disability and 40% of the women with moderate disability are not working, compared to 33.3% of the women with mild disability. No women with severe disability is working for wages while approximately 7% work as unpaid family member (Figure 17).

Figure 17: Work status of those who have ever worked, by disability level, for men (blue) and women (red).

100 90 80 70 60 47.5 50 41.2 40 35.3 28.6 28.6 30 26.7 21.8 20.8 20 14.3 14.3 14.3 10 0.8 0 0 0 0.8 0 0 0 Not working Working for wages Self-employed Working unpaid Retired, health Retired, age family member condition

Mild Moderate Severe

100 90

80 71.4 70 60 50 50 43.2 37.8 40 33.3 30 18.9 20 16.7 14.3 7.1 7.1 10 0 0 0 0 0 0 Not working Working for wages Working for wages, on Self-employed Working unpaid family leave member

Mild Moderate Severe

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2.7 Education

Figure 18 shows highest educational achievement. For men, the highest the level of disability, the higher the proportion of men with no education: from all men with no education, approximately 43.3 % have moderate disability. For women, allmost all women with no education have either moderate or severe disability.

Figure 18: Highest level of education achieved, by disability, for men (blue) and women (red).

60 52.9 49.6 50 45.3 43.3 43.8 43.8

40 35.8 35.9

28.2 30 26.5 20.5 20 14.9 14.7 15.6 12.5

10 6 5.9 1.7 3.1 0 0 No education Elementary Vocational Secondary Higher

No Mild Moderate Severe

120

100 100

80

57.1 60 52.8 44.7 42.9 40 40 41.7 40 33.3 25 20 20

0 2.4 0 0 0 0 0 0 0 0 No education Elementary Vocational Secondary Higher

No Mild Moderate Severe

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2.8 Environmental factors

Environment is broadly defined in the MDS as the external factors that contribute to the lived experience of the individual, such as the availability of assistive devices, a supportive family structure, the attitudes of peers, accessibility to health care or accessibility of transportation. Environmental factors disclosure needs, inequalities and barriers.

2.8.1 General environment

Very high proportions of men and women with any level of disability, but mostly the ones with severe disability, experience the physical environment as hindering or very hindering (Figure 19). Transportation, health facilities, workplace or school, and shops, banks and post offices in the neighborhood are among the most hindering ones.

Figure 19: Percentages of persons reporting that aspects of the general physical environment are hindering or very hindering, by disability level, for men (blue) and women (red). 100.0 90.0 88.9 90.0 90.0 85.7 80.0 70.0 63.1 60.0 60.0 60.0 49.5 50.0 50.0 43.0 40.0 40.0 36.0 34.4 27.5 29.7 30.0 30.0 24.3 20.7 20.0 15.6 20.0 11.9 11.8 13.7 11.7 7.9 7.8 8.6 8.6 7.8 10.0 4.5 0.0 0.0 0.8 2.0 2.0 0.9 0.0 workplace or health facilities places to shops, banks, places of transportation dwelling toilet of the temperature, lightning, noise school socialize post offices worship dwelling terrain and and crows climate

No Mild Moderate Severe

100.0 90.5 88.9 90.0 82.5 78.7 81.4 79.4 80.0 68.2 69.8 70.0 60.0 50.0 50.0 50.8 50.0 46.2 39.7 39.6 38.0 37.3 36.7 40.0 31.6 30.0 16.7 20.0 12.5 12.5 12.5 8.3 8.9 7.6 10.0 0.0 0.0 0.0 0.0 0.0 0.0 workplace or health facilities places to shops, banks, places of transportation dwelling toilet of the temperature, lightning, noise school socialize post offices worship dwelling terrain and and crows climate

Mild Moderate Severe

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2.8.2 Personal assistance

A total of 26 men (70% with severe disability) and 57 women (58.7% with severe disability) report having personal assistance, mostly unpaid assistants (Table 6).

Of those, eight men (75% with severe disability) and 16 women (29.7% with severe disability) respond that they would need more assistance. Altogether 27 men and 7 seven women report having no personal assistance but needing it.

Table 6: Percentage of persons reporting personal assistance, by disability and sex. Men (N=300) Women (N=150) N No Mild Moderate Severe N Mild Moderate Severe

Persons with personal assistance 26 11.8% 3.1% 8.1% 70% 57 0 25.3% 58.7%

Paid or charity organizations assistants 4 20% 50% 12.5% 14.3% 6 - 10% 10.8%

Unpaid assistants (family members, friends or 17 60% 0% 87.5% 100% 55 - 100% 94.6% volunteers) Both paid and unpaid assistants 3 20% 0% 12.5% 14.3% 5 - 10% 8.1% Persons with personal assistance who need 8 0 0% 22.2% 75% 16 - 23.8% 29.7% more assistance Persons with no personal assistance who need 27 4.3% 7.9% 13.7% 50% 7 0 3.4% 19.2% assistance

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2.8.3 Attitudes of others

Extreme problems with attitudes of others are experienced by relatively high proportions of persons across disability levels (Figure 20 and Figure 21). However, persons with severe disability are frequently worst off: not being able of making big decisions in life is an extreme problem for 60% of men with severe disability, while people not expecting much of oneself is a problem for 54% of women with severe disability. Women have more problems with attitudes, across disability levels.

Figure 20: Percentage of persons endorsing mostly or completely to questions about attitudes of others, by disability level, for men (blue) and women (red). 100 90 80 70 60 60 52.9 50 42.3 38.7 40 40 30 30.5 30 28.9 27.3 30 25.5 23.5 21.6 20 17.1 20 13.3 11.7 10 9.4 10.8 10 3.9 3.9 3.9 3.6 0 Getting involved in Being treated Considering oneself People become People don't expect Living with dignity society unfairly a burden to society impatient with you much from you is a problem

No Mild Moderate Severe

100 90 80 70 60 54 50 41.3 39.7 40 34.9 34.9 28.6 30 22.8 25 22.8 20 16.5 13.9 13.9 8.9 10 0 0 0 0 0 0 Getting involved in Being treated Considering oneself People become People don't expect Living with dignity society unfairly a burden to society impatient with you much from you is a problem

Mild Moderate Severe

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Figure 21: Percentage of persons endorsing no or not at all to questions about attitudes of others, by disability, for men (blue) and women (red). 100 90 80

70 60 60 50 40 30 20 20 17.6 20 20 13.3 14.1 13.7 11.8 11.8 9.9 9.9 10 7.9 8.1 5.5 8.1 10 2 3.9 3.6 0 Participate in family Make own choices Make big decisions in Feel that others accept Feel that others decisions about your day-to-day your life you respect you life

No Mild Moderate Severe

100 90 80 70 75 75 60 51.9 53.2 47.6 50 40 32.9 50 25.4 30 21.5 20.6 17.5 20 13.9 11.1 10 0 0 0 Participate in family Make own choices Make big decisions in Feel that others accept Feel that others decisions about your day-to-day your life you respect you life

Mild Moderate Severe

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2.8.4 Access to information

Table 7 reports access to information by disability level. The largest proportions of men with no or mild disability have partly access to information while the largest proportions of men with moderate or severe disablity, have a little and not at all access, respectively. Most women with mild or moderate disability have no access to information while most women with severe disability have partly access. Figure 22 shows the rates of persons with not at all or little access to information they need or want by disability level and sex.

Table 7: Percentage of persons with access to the information (Do you have access to the information you need or want?) by disability level and sex.

Do you have Men Women access to the Disability level Disability level information you need or want? No Mild Moderate Severe Mild Moderate Severe Not at all 3.9% 4.7% 5.4% 30% 75% 46.2% 30.2% A little 15.7% 21.9% 45.9% 20% 0 14.1% 3.2% Partly 33.3% 50% 36.9% 10% 25% 23.1% 42.9% To some extend 17.6% 14.1% 9% 20% 0 10.3% 17.5% Completely 29.4% 9.4% 2.7% 20% 0 6.4% 6.3% Total 100% 100% 100% 100% 100% 100% 100%

Figure 22: Rates of persons with not at all or little access to information they need or want, by disability and sex. 100 90 80 75 70 60.3 60 51.3 50 50 40 33.4 30 26.6 19.6 20 10 0 No Mild Moderate Severe

Men Women

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2.8.5 Regular use of medication

Figure 23 shows regular medicine intake by disability level: as expected, the higher the disability level, the higher the proportion of persons taking medicines, for men and women.

Figure 23: Regular medicine intake (percentages of persons) by disability level and sex. 80 70 68.3 70

60

50 36.7 40 34.2

30 25

20 10.9 10

0 No Mild Moderate Severe

Male Female

2.8.6 Assistive products and modifications

Figure 24 shows unmet needs of assistive products and facilitators among those who do not already use products, by disability level and sex.

Figure 24: Percentage of men (blue) and women (red), who do not use products, reporting unmet needs of assistive products and modifications, by disability level. 100 90 80 70 70 60 60 50 48.2 50 44.5 40 40 33 28.6 30 22.2 23.6 16.7 17.3 16.5 20 12.8 12.1 10 10 10 4.9 1.6 0.8 1.8 0.8 2.7 0 Mobility and Seeing Hearing Cognition Work Education Home Community self-care

Mild Moderate Severe

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50 43.8 45 40 35 30 25.4 22.2 25 21.1 20.7 20 18.2 13.9 14.5 15 12.5 9.5 8.9 10 5.1 4.7 5 2.5 2.2 0 0 0 0 0 0 0 0 0 0 Mobility and Seeing Hearing Cognition Work Education Home Community self-care

Mild Moderate Severe

Very few persons in the sample report the use of assistive technologies, and the most commonly used ones are for mobility and self-care (11 men and 20 women use them, almost all with severe disability) and seing (10 men and 7 women use them, almost all with severe disability) (Table 8).

Table 8: Percentage of persons reporting use and additional need of assistive products and modifications by disability level and sex. Men Women N Mild Moderate Severe N Mild Moderate Severe Mobility and self-care Use 11 10% 33.3% 80% 20 - 30.8% 80% Use but need more 11 100% 100% 100% 18 - 50% 100% Seeing Use 10 50% 26.3% 25% 7 - 15.4% 25% Use but need more 6 50% 60% 100% 4 - 50% 60% Education Use 1 10% 0% - 0 0% 0% 0% Use but need more 1 100% - - 0 - - - Modifications home Use 3 0% 0.9% 20% 1 0% 0% 1.6% Use but need more 1 - 0% 50% 1 - - 100% Modifications in the Use 4 0.8% 2.7% 0% 0 0% 0% 0% community Use but need more 5 100% 100% - 0 - - -

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2.9 Health care responsiveness

Figure 25 reports inpatient and outpatient health care utilization and access to care, by disability level and sex. Regarding men, 20% of men with severe disability report that they didn’t receive the care they needed while 42.9% of the women who needed inpatient care report that they have not received it.

Figure 25: Percentage of men (blue) and women (red) who used and didn’t get care by disability level. 120 100 100 100 92.2 87.8

80 60 60

40 20 20 10.9 12.2 11.1 0 0 0 0 3.4 2.5 0 Inpatient care used in the Inpatient care needed but not Outpatient care used in the Outpatient care needed but past 3 years received past year not received

No Mild Moderate Severe

120 100 100

74.1 80 70

60 42.9 40 28

20 10.3 0 0 0 0 2.9 0 Inpatient care used in the Inpatient care needed but not Outpatient care used in the Outpatient care needed but past 3 years received past year not received

Mild Moderate Severe

Figure 26 shows how satisfied persons are with the health care they receive. A clear difference between women with mild disability and women with moderate to severe disability is observed, with the latter being considerably less satisfied with all aspects. For men, the pattern is also observed but less clear, what could be due to the fact that only 3.3% of men have severe disability.

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Figure 26: Percentages of men (blue) and women (red) endorsing aspects of the health system as good or very good, by disability. 100 88.9 88.9 90 84.4 81.2 77.8 80 77.8 77.8 77.8 80 76.6 70 70 70 66.7 67.2 67.2 67.2 57.8 55.6 60 54.4 52.2 48.9 48.9 50 44.4 44.4 42.2 40 40 37.5 40 30 30 30 30 25 25.6 17.8 20 20 11.1 10 0 Waiting Being How clear Being Privacy Easeness of Cleanliness Satisfaction Satisfaction times treated with health involved in choosing a of the health with how the with how respect providers making health care facility health care health care explain decisions for provider services are in Pakistan things your run in involves you treatment Balochistan in deciding what services to provide and where

No Mild Moderate Severe

100 100 100 100 100 90 83.3 80 66.7 66.7 66.7 70 59.6 60 56.1 49.148 48 49.1 5049.1 50.9 50 45.6 46 44 44 36.840 38 40 34.5 36 30 20.4 20 10 0 Waiting times Being treated How clear Being involved Privacy Easeness of Cleanliness of Satisfaction Satisfaction with respect health in making choosing a the health with how the with how providers decisions for health care facility health care health care in explain things your provider services are Pakistan treatment run in involves you in Balochistan deciding what services to provide and where

Mild Moderate Severe

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2.10 Well-Being

The MDS contains eight questions about quality of life, that are suitable for calculating a quality of life score ranging from 8.0 to 40.0, higher scores pointing out higher quality of life. As shown in Figure 27, the higher the level of disability, the lower the quality of life.

Figure 27: Mean quality of life score, by disability level and sex. 40.00 34.53 35.00

28.75 30.00 27.64 25.97 25.00 22.89 20.50 20.00

15.00

10.00

5.00

0.00 No Mild Moderate Severe

Male Female

Disclaimer

The authors are staff members of the World Health Organization. The authors alone are responsible for the views expressed in this publication and they do not necessarily represent the decisions or policies of the World Health Organization.

WHO/NMH/NVI/18.17

© World Health Organization 2018

Suggested citation. Model Disability Survey General Results: Ziarat District, Balochistan Province, Pakistan. Geneva: World Health Organization; 2018 (WHO/NMH/NVI/18.17). Licence: CC BY-NC-SA 3.0 IGO

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