5

6

8

10 10 12 14 14 14 15 15 16 16 17 17 18 19 19 20 21 21

22 23 25 28 29 30 31 32 33

34

34 35 37 38 39 40 40 41 42 42 43 44 44 45 46

48 48 49 49 50 50 51 51 51 51 51 52 52 52 53 53

54 54 54 54 55 55 55 56 56

58

58 58 58 58 b 59 59 6.7 Resource Mobilization 60 6.8 Provision of Suitable Facilities and Services 60

SECTION 7 ANNEXURES Annex I: Recommendations of Focus Group Discussion at 62 Peshawar (April 2, 2008) Annex II: Recommendations of Focus Group Discussion at 64 Lahore (April 5, 2008) Annex III: Recommendations of Focus Group Discussion at 67 Karachi (April 8, 2008) Annex IV: Recommendations of Focus Group Discussion at 70 Islamabad (April 12, 2008) Annex V: List of Participants of the Focus Group Discussion at 74 Peshawar (April 2, 2008) Annex VI: List of Participants of the Focus Group Discussion at 76 Lahore (April 5, 2008) Annex VII: List of Participants of the Focus Group Discussion at 79 Karachi (April 8, 2008) Annex VIII: List of Participants of the Focus Group Discussion at 81 Islamabad (April 12, 2008) Annex IX: References 83 PREFACE Research Report: Journey of Hope (A report on the status of persons with in and the way forward)

According to the 1998 Pakistan census, approximately 2.49 percent of the population has some form of . Translated in absolute numbers, nearly 3.2 million people in Pakistan are disabled out of which 1.37 million are females and 1.99 million males; while 37.2% fall in 0-14 age group. In Pakistan persons with disabilities are still subjected to conventional exclusion and extreme stigmatization while globally there is a greater acknowledgement that most persons with 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 for Pakistan for bringing about positive changes in the social attitudes toward persons with disabilities and paving the way for an equal and inclusive world. The Programme—one of a series of several different thematic programmes being held to foster awareness of modern-day issues facing the Ummah—is being held during the year that commemorates the Golden 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 persons with 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 of Pakistan and with input from major institutions and organisations working with people with all forms of disabilities. The draft report was peer reviewed at four Focus Group Discussions organized at Peshawar, Lahore, Karachi and Islamabad 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, analyses existing policies and laws, highlights the challenges faced by both these individuals as well as these organizations, and gives 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 Organizations Working for People with Disabilities, Pakistan”, (NOWPD,P). Participants of the four Focus Group Discussions cited the absence of such a network as a major impediment in their efforts to foster an enabling policy environment addressing the needs of persons with disabilities. Hence, it is expected that the Network would facilitate these organizations in this regard.

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

I anticipate that this report will lead to several new initiatives. On its part, the Aga Khan Council for Pakistan is committed to take forward some key actions, foremost among them being the launch of Network.

Iqbal . S. Walji President His Highness the Aga Khan Council for Pakistan Acronyms

ADL Activities of Daily Living AIDS Acquired Immune Deficiency Syndrome AIOU Allama Iqbal Open University AJK Azad Jammu & Kashmir AMC Army Medical Corps

Association for Rehabilitation of Physically ARPD Handicapped CBO Community Based Organisation CBR Community Based Rehabilitation CWDs Children with Disabilities DGSE Directorate General of DHQ District 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 International Classification of Impairments, ICIHD 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 National Council for Rehabilitation of Disabled NCRDP Persons 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 Provincial Council for Rehabilitation of Disabled PCRDP Persons 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 Vocational Rehabilitation Employment For VREDP Disabled Persons WHO World Health Organization Executive Summary

This report is based on secondary data available in the country on the prevalence of disability, challenges faced by persons with disabilities (PWD) and organizations working for them and possible initiatives to address these challenges. The report was finalized through a series 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 and reflects a paradigm shift from medical model to, in common parlance, a socio-economic model. It describes three important components that constitute disability which include (i) health condition (disease/disorder), (ii) personal activities and (iii) participation in society and 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 of inclusion of disability in the national census, statistics on disability suffer from inadequacies such as lack of standardized definitions. The WHO estimate of disability for the developing countries was found to be 10% of the total population. These were, however, not confirmed during the survey of disability of twin cities of Rawalpindi / Islamabad carried out by the Directorate General of Special Education during 1985-86. The Pakistan Census Organization in its census carried out in 1998 estimated a population of PWDs 3.293 million against the total 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 rehabilitation services and facilities for PWDs and students enrolment. There were only few institutions at the time of independence which reached up to 531 units in 2006. A sharp rise in the pace of development of institutions for PWDs was witnessed after the observance of International Year of the Disabled Persons (IYDP), 1981 which was followed by the establishment of Directorate General of Special Education in 1985. A variety of institutions during the decade 1980-1990 were established including the construction of purpose built premises. The existing institutions are catering to the educational needs of only 4% of the children of school going age. The data transpires that there is an acute shortage of vocational training facilities for PWDs. Rural areas with nearly 3/4th of the population are largely neglected and depend upon 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 PWDs which 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 Provincial Councils for the Rehabilitation of the Disabled. The other policy reforms include National Policy 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 DGSE recently 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 organizations working 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 free buildings, micro-credit facilities and equipment).

Proposed Initiatives to Address the Challenges

This section suggests a variety of initiatives to address the challenges identified. Most notable among them are: establishment of a national network for organizations working for persons with disabilities; 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 discussion of each is useful by way of framing the main body of the report. The themes are: (i) models of 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 from the charity and medical models of disability towards social model of disability. The various models can be described briefly as follows:

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

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

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

• The rights-based model of disability builds on the insights of the social model to promote creation of communities which accept diversities and differences, and have a non-discriminating environment in terms of inclusion in all aspects of the life of society.

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

1 This section draws from: People with Disabilities in : 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 institutions of 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: “.an umbrella term covering three dimensions: (i) body structures and function; (ii) personal activities; and (iii) participation in society. These dimensions of health-related experience are termed “impairments of function and impairments of structure”, “activities” [i.e. nature and extent of individual functioning due to impairments], and “participation” [the nature and extent of a person’s involvement with life situations] respectively”.

While the language of ICIDH-2 is dense, the intuition is simple. Limitations on PWDs participation in the life of their society are created by the interaction of general environmental factors (e.g. the structural environment; societal attitudes), individual-specific factors (e.g. , age or education), and the impairment(s) that the individual has. The ICIDH-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 Factors A. Environmental B. Personal C. Institutional

The analysis of the literature on disability reveals that a unified understanding of the concept or definition does not exist among service providers i.e. surgeons, physicians, special educators and representatives of NGOs. Classification of disabilities and standards of functional disabilities in their broader manifestation were found to be vague that can be attributed to some extent to international or political pressures to certify individuals for disability 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 three important dimensions:

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

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

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

1.2 Classification of Disabilities3

There have been numerous attempts to devise disability classification systems in the , in part because of the rise of social insurance programs such as workmen’s compensation, veterans’ benefits, and social security programs. Disability measures have also been problematic as public policy making tools. The eligibility criteria of the nation’s social security insurance programs have been criticized for relying on the narrowly defined criteria of the disease to determine disability. Another important source of disability classification has been health interview surveys. From the time of their introduction to the United States, these surveys have grown increasingly sophisticated, and by the 1950s Katz and Lawton had developed short sets of survey questions based on behavioural theories of human function. These indexes are known as the Activities of Daily Living (ADL), which measure abilities in six functions (bathing, dressing, , transfer, continence, and feeding). Despite their widespread use, however, each of the classification systems that have come 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 these measures have been attempted, but there has been no consensus on a system that could provide a sufficiently broad understanding of disability. These and other specific measures provide insight into the way the disability affects important parts of most people’s lives, but their scope is too narrow. Moreover, health care measures are now called on to assess the quality of life, but without a fuller perspective on the effects of disability, such classification and measurement systems do not have a convincing claim to make such assessments.

In the search for solutions, epidemiologists, demographers, physicians, insurers, and other health-related professionals have looked into classification systems that attempt to provide a comprehensive framework for understanding and acting on both the physical and social dimensions of disabilities. Several attempts have been made to classify a broad range of disability phenomena into categories organized according to various levels, from the pathological to the individual to the social, on which disabling conditions exist. The World Health Organization’s International Classification of Impairments, Disabilities, and Handicaps (ICIDH) is widely used and frequently discussed. It addresses somatic, cognitive, economic, and psycho-social dynamics. The ICIDH system categorizes a wide range of disease consequences and suggests points of intervention (to prevent further development) and forms of assistance to help individuals cope with their difficulties. The form and organization 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 by a theory of “planes of experience” in the development of illness and disability. This gives rise to four main categories: disease/disorder, impairment, disability, and handicap.

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

In the special education context, physical disability or orthopaedic impairment includes severe disabilities that adversely affect educational performance. There is a wide range of disabilities in this category including such conditions as , spina bifida amputations or limb abscess and muscular dystrophy. There are also a variety of health related problems which are termed as special health impairments that require special medical care and educational services. Health impairments include convulsive disorder, cystic fibrosis, heart disease sickle cell disease, haemophilia, asthma, rheumatic fever, cancer, AIDS or any other chronic or acute health condition that limits strength vitality and alertness that adversely affect the educational performance.

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

Hearing impairment refers to deafness that varies according to the extent of that can easily be assessed through a procedure of audiometry. Mental retardation is different from mental sickness or psychological functional disorders arising 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 is not would be preferable.

The task relating to the assessment of disability in Pakistan has been assigned to Disability Assessment Boards constituted at the District Headquarter Hospitals under the Chairmanship of 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 cause of 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 or environmental. Biomedical causes have their origin within the body of the individual whereas socio-cultural and environmental causes of disabilities are those that originate outside the individual’s body. This includes not only those stemming from the social, cultural and physical environment but also those causes that result from the individual’s life-style and behaviour.

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

1.3.1 Prenatal Causes

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

1.3.2 Chromosomal/Genetic Causes

Chromosomal abnormalities can involve the loss, gain, or exchange of genetic material from a chromosome pair. Such abnormalities often cause miscarriages, but may occasionally result in a baby with some kind of disability. Down’s syndrome, a congenital condition that usually includes physical health problems and mental retardation, is caused by an abnormality of the chromosomes. The twenty-first chromosome set is a triplet instead of a pair, hence the other name of this syndrome, Trisomy 21. Down’s syndrome is often associated with the mother’s age. The incidence rate is high when mothers are extremely young, low for mother in early adulthood, 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 briefly explained 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 of sight in adulthood. It affects about one in 5000 individuals world wide. Individuals who suffer 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 inheritance patterns: autsomol dominant; autosomal recessive; and x-linked or mitochondrial (maternally inherited), however, some families with RP exhibit more complex inheritance patterns. Age of onset in the majority of cases is during the 20s which severely impacts individual’s activities.

Incidence of RP can be reduced through genetic counselling. In the context of Pakistan, it is worthwhile to note that there is a non-governmental organization, the Pakistan Foundation Fighting Blindness - a pioneering research organization, engaged in research on retinitis pigmentosa in collaboration and cooperation with researchers and ophthalmologists of high national and international repute. It is involved in collection of data on affected families since 1995 and has database of more than 12000 visually impaired individuals (Research Paper, Presented by: Dr. Farhat Jabeen).

1.3.4. Disorder (ASDs) (a)

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

Different people with autism can have very different symptoms. Health care providers think of autism as a “spectrum” disorder, a group of disorders with similar features. One person may have mild symptoms, while another may have serious symptoms, but both have an autism 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 to describe autism; this category includes the autism spectrum disorders above, plus Childhood Disintegrative 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 communication disorders where 'normal' speech is disrupted. This can include stuttering and lisps. Someone totally 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 speech impediments, 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. abuse may also be a cause in some cases.

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

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 by damage to the motor control centers of the young developing brain and can occur during (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 the course of a person's lifetime

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

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

Despite years of debate, the cause of the majority of cases of CP is uncertain. Some contributing causes of CP are asphyxia and hypoxia of the brain, birth trauma, premature birth, infections and certain infections in the mother during and before 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 cause progressive muscle weakness. Muscular dystrophies are characterized by progressive skeletal muscle weakness, defects in muscle proteins, and the death of muscle cells and tissue.

These conditions are inherited, and the different muscular dystrophies follow various inheritance patterns. The best-known type, Duchenne muscular dystrophy (DMD), is inherited in an X-linked recessive pattern, meaning that the mutated gene that causes the disorder is located on the X chromosome, one of the two sex chromosomes, and is thus considered sex-linked. In males (who have only one X chromosome), one altered copy of the gene in each cell is sufficient to cause the condition. In females (who have two X chromosomes), a mutation must generally be present in both copies of the gene to cause the disorder (relatively rare exceptions, manifesting carriers, do occur due to dosage compensation/X-inactivation). Males are therefore affected by X-linked recessive disorders much more often than females. A characteristic of X-linked inheritance is that fathers cannot pass X-linked traits to their sons. In about two thirds of DMD cases, an affected male inherits the mutation from a mother who carries one altered copy of the DMD gene. The other one third of cases probably results from new mutations in the gene. Females who carry one copy of a DMD mutation may have some signs and symptoms related to the condition (such as muscle weakness and cramping), but these are typically milder than the signs and symptoms seen in affected males. Duchenne muscular dystrophy and Becker's muscular dystrophy are caused by mutations of the gene for the dystrophin protein and lead to an overabundance of the 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 influences include external agents, infections, toxins, and maternal health. External agents that can cause prenatal damage include injury and radiation. Any violent blow to the mother’s abdomen can also hurt her child. Radiation such as x-rays can affect the foetus. Some infections the mother suffers can damage the infant when the disease organisms cross the placental barrier. Rubella can cause severe disabilities, including blindness and mental retardation. Syphilis and Acquired Immune Deficiency Syndrome (AIDS) can not only affect the 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. Drugs such as heroin and cocaine can cause decreased central nervous system function and addiction 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, and calorie 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 greater risk 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 are larger, more robust infants.

1.3.9 Poverty related Causes

Poverty is the root cause of social problems including the deprivation of basic necessities like food, clothing and shelter. It also leads to several social implications such as malnutrition, ill health 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 high vulnerability to risks and shocks. The main cause of rise in poverty in Pakistan lies in the wide spread structural inequality that leads to the exclusion of poor from both owning and accessing assets and services. The main reasons of increase in poverty in urban areas have been unemployment and in rural areas is lack of assets.

In 2001, on the basis of Pakistan Household Integrated Economic Survey (HIES) data and using adult equivalent requirements of 2350 calories per day, consumption-based absolute poverty incidence (i.e. percentage of population below the poverty line) was estimated to be 32.1%: 38.9 %in rural areas and 22.7% in urban areas as shown in table below:

Count 1992-93 1993-94 1996-97 1998-99 2000-01

HIES HIES HIES HIES HIES

Poverty Incidences: Head Count (Percentage)

Overall 26.8 28.7 29.8 30.6 32.1

Urban 28.3 26.9 22.6 20.9 22.7

Areas

Rural 24.6 25.4 33.1 34.7 39.0

Areas

Source: Planning Commission of Pakistan

It is often quoted in international reports that 20% of the poor in developing countries are disabled. No empirical evidence with regard to socio-economic profile of the PWDs is available. The Poverty Assessment Surveys/Studies, however, reveal that one third of the Pakistani population continues to live below the poverty line and there are alarming gaps in social attainment even after six decades of development. The existing poverty prevalence rate can safely be co-related to the population of PWDs that at least one third of the population of persons 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 be no denial that external environment like imbalance diet, poor housing conditions, lack of access to clean drinking water and poor facilities have a direct bearing on human growth and development. Survey of services and facilities for the PWDs carried out by the DGSE in 2006 clearly indicates a wide gap in students’ enrolment. It was astonishing to note that only 4% of children with disabilities utilize educational facilities. The conditions in employment sectors are in no way different.

The socio-economic profile of the PWDs of our neighbouring country (India) contained in the World Bank document-2007 confirms the hypothesis that disability rates tend to rise with country’s income level. It shows substantially higher rates of illiteracy among PWDs population. The share of disabled children who are out of school is dramatically higher than other 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 of scheduled casts and tribe population (generally considered to have poor educational outcomes). Similarly PWDs participation in labour market and employment is also low compared 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 from this 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 have congenital disabilities than any other infant. They are at risk because of their immature bodily development and lack of preparation to survive independently. Many premature infants require the supplemental use of oxygen and some suffer a form of blindness called retinopathy caused by an 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 suffers damage 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 done to the baby’s brain. Sexually transmitted diseases (STD) can be contracted during vaginal delivery. These infections include syphilis, AIDS, gonorrhoea and herpes. Gonorrhoea affects the eyes 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 environmental factors including the following:

Childhood Injuries: The causes and circumstances of childhood injuries show a distinct pattern 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-2007 6 Situation Analysis, M/S Arjumand Associates, 2004 7 Situation Analysis, M/S Arjumand Associates, 2004 involves falling from bed or from parents, siblings’ or grand parents’ arms. It is difficult for young parents to imagine all the dangers to which an infant may be exposed especially if it is their first child and they have no experience of child care. In Pakistan, with exception of educated and affluent social classes, access to child-care training for pregnant women is non-existent. When children begin to walk, their movements are not fully coordinated. An active child knocks into the corners of furniture, falls over articles of furniture onto which they climb to obtain something from shelf or cupboard. Heavy objects sometimes fall on children when they try to take them off high shelves. Children often hurt their fingers while closing doors and drawers. Of paediatric causalities, a large proportion of injuries involve bruises, broken bones, and burns from hot objects like stoves or hot teapots when children reach out to help themselves.

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

Childhood Diseases: Disabling conditions can sometimes result from common infectious diseases. Childhood diseases can retard a victim’s future development. One of the severe causes 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 cause mental retardation, is a possible complication of such childhood illnesses as mumps, chicken pox, and measles. Measles sometimes cause visual impairment. Ear infections that often accompany children’s colds can result in conductive hearing loss. Deafness can be genetic, it can be caused by illnesses such as mumps, measles, meningitis or rubella (either during pregnancy or in childhood) Deafness can be caused by repeated exposure to loud noise such as 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 of biological impairments and increase the likelihood of disability. Environmental deprivation has a debilitating effect on the development of abilities such as language use, and adaptive behaviour. Cognitive deprivation includes poor nutrition, poor housing, lack of social interaction and limited exposure to varied experiences. These conditions are often associated with 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’s development. Hunger produces nervousness, irritability and decreased ability to learn. Severe deficiency of vitamin “A” can cause blindness in children after they are weaned (World Health Organization, 1992). A protein-calorie deficit during first six months of life affects the mental development. Economic hardships due to lack of employment opportunities and low family income can lead to late or limited schooling, which can result in intellectual impairments and functional limitations.

1.3.13 Causes in Adolescence

Adolescence or teen age years are labelled as an age of storm and stress. Adolescents become vulnerable to injuries when they perform dangerous acts of bravado. They are often involved in high risk physical activities because of their active life style. The most common causes of the injuries sustained include falls from motorcycles, motor car accidents and physical violence. Juvenile delinquency occurs relatively often among youth coming from broken families with a history of criminal acts or mental disorders. Drug addiction among youth is another menace of the 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 tranquilizers readily available in the market.

1.3.14 Causes in Old Age

As the people grow older the chances of disabilities increase due to degenerative changes/conditions which impact the individual’s quality of life such as limitation of mobility and agility. Chronic health conditions include rheumatism and arthritics. Strokes may 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 encounter problems because of mental health conditions, senility, , deafness, blindness, feeling of 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 1988 spearheaded an important attempt to identify and compile the world’s existing disability statistics. Most of DISTAT statistics were collected using the original International Classification of Impairments, Disabilities, and Handicaps (ICIDH) classification system, thus eliminating some of the definition problems that had previously hampered comparison of international data sets. DISTAT has grown to contain disability statistics from 177 national studies from 102 countries. The data sets are formatted by the United National Statistical Office (UNSO) for electronic dissemination. The estimates of disabled population of 175 countries show the proportion of people with disabilities in High Human Development (HHD), Medium Human Development (MHD) and Low Human Development (LHD) countries to be 9.9%, 3.7% and 1.0% respectively. The total global disabled population is estimated to be between 235.39 and 549.18 million; of HHD countries 124.23 million; the range for the MHD countries estimated to be between 93.52–250.22 million for the 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 India Pakistan Sri Lanka Census/HH Survey 1.6 2.2 2.5 1.6 Special 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 on disabilities suffer from inadequacies such as lack of standardized definitions, inconsistencies in the inter-census data sets and their consequent incompatibility for national and international comparisons. Data sets on the disabled have been collected in the national population census of 1961, 1973 and 1981. During the period 1984-1985, the Federal Bureau of Statistics (FBS) conducted a national survey to fill this data gap. A national sample of 5,638 households was surveyed to assess the incidence of disabilities. Unfortunately, the categories 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 was conducted 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 when compared 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 mean anything? The wide variations in data would make one question the credibility. In view of the unreliability of these data, what basis do the disability programme planners have? On the whole, data on the disabled population in Pakistan present a number of problems including those of definitions, reference periods, inconsistent categories, heavy dependence on the respondent’s self-reporting that obscures objectivity and makes enumeration of disabilities difficult. The demography of disability is difficult. Counting persons with disabilities is far more challenging than is counting males. That is because disability is not just a status condition, entirely contained within the individual. Rather, it is an interaction between medical 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 of 135,668 1,257,454 371,420 PWDs

Percentage of total 0.31 2.07 0.44 population

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 of disability under seven categories: Crippled; Insane; Mentally Retarded; Multiple Disability, Blind; Deaf & Mute and Others. As reflected in Graph-1, the total number of PWDs was found to be 3,293,155 against the total population of 132,352,279 giving an overall percentage of 2.49.

Graph-1

Population of Disabled Persons (National)

Disabled Population, 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 Percentage of Disabled Persons in Pakistan by category

45 40 35 30 25 20 15 10 5 0 Visually Physically Mentally Others Handicap Handicapped Handicapped

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

Disabled Population (in millins) by Gender & Urban /Rural Residence - Pakistan 3.5 1998 3

2.5

2

1.5

1

0.5

0 Male Female Total

Urban Rural Total

Source: National Population Census of Pakistan, 1998

2.2 Province Wise Disability Prevalence

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

Graph – 4 Number of Persons with Disabilities by Province Source: National Population Census of Pakistan, 1998

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

Graph - 5

Disabled Population as % of The Total Population of Each Area 7 . 6 4 2 8 2 3 . 4 1 2 . K, . 2 , 2. 2 2 , , A , AJ n N P ab a F t nj FA is u h NW dh, 3.05 P c n i lo S a B

Source: National Population Census of Pakistan 1998.

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

Disability Wise Disabled Population Compared (%) 60

55

50 45 40

35

30 25

20

15 10

5 0 Punjab Sindh NWFP Balochistan FANA AJK Visually Handicapped Hearing Impaired Physically Handicapped Insanity Mentally Handicapped More Than One Disability Others

Source: National Population Census of Pakistan, 1998

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

Graph -7 Percentage of the Total Disabled Population by Category

V i sual l y Handi capped, 8. 48

Hear i ng I mpai r ed, 8.17 Other s, 39. 83

P hysi cal l y Handi capped, 20.83

Insani ty, 6 .75 M or e T han O ne Di sabi l i ty, 8 .07 M ental l y Handi capped, 7. 87

Source: National Population Census of Pakistan, 1998 2.4 Disability Prevelence In Sindh

A majority of the PWDs fall in the “Other” category (53.28%) whereas physically handicapped constitute 10.56%. 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%).

Graph-8

Percentage of Total Disabled Population by Category

Visually Handicapped, 7.48

Hearing Impaired, 6.18

Physically Handicapped, 10.56

Others, 53.28 Insanity, 6.13

Mentally Handicapped, 7.45

More Than One Disability, 8.92

Source: National Population Census of Pakistan, 1998 2.5 Disability Prevalence in NWFP

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

Graph-9 Percentage of Total Disabled Population by Category

Visually Handicapped, 7.24

Hearing Impaired, 7.69

Others, 31.92

Physically Handicapped, 31.7

More Than One Disability, 8.11 Mentally Handicapped, Insanity, 5.9 7.44

Source: National Population Census of Pakistan, 1998 2.6 Disability Prevelence In Balochistan

A little more than half of the total disabled population (54.97%) belongs to the “Others” category. The physically 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%) and visually handicapped (8.42%).

Graph-10

Percentage of Total Disabled Population by Category

Visually Handicapped, 8.42 Hearing Impaired, 5.24

Physically Handicapped, 14.81

Others, 54.97

Insanity, 4.6

Mentally Handicapped, 5.61 More Than One Disability, 6.35

Source: National Population Census of Pakistan, 1998 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%).

Graph - 11

Percentage of Total Disabled Population by Category

Visually Handicapped, 8.52

Hearing Impaired, 16.18 Others, 37.73

More Than One Disability, 6.24 Physically Handicapped, 21.67

Mentally Handicapped, Insanity, 4.97 4.69

Source: National Population Census of Pakistan, 1998 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 the category of physically handicapped. The other categories range from insane (7.12%), mentally handicapped (8.17%), visually handicapped (8.88%), multiple handicapped (10.17%) and hearing impaired (10.25%) of the population with disabilities.

Graph-12

Percentage of Total Disabled Population by Category

Visually Handicapped, 8.88 Hearing Impaired, 10.25 Others, 31.95

More Than One Physically Disability, 10.17 Handicapped, 23.46

Mentally Handicapped, Insanity, 7.12 8.17

Source: National Population Census of Pakistan, 1998 SECTION 3: DEVELOPMENT OF SPECIAL EDUCATION PROGRAMMES IN PAKISTAN

3.1 Evolution Of Disability Programme

There is evidence of historical developments that underpin educational provisions for the disabled in Pakistan. The earliest formal disability rehabilitation center were a government 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 of deaf children in the late 1940s resulted in the formation of a “Deaf and Dumb Welfare Society” at Lahore in 1949, and a special school opened afterwards. Soon after independence in 1947, a more extensive integration of children with visual impairments began in a middle school at Pasrur. However, children with various impairments and disabilities continued to be part of the normal enrolment throughout primary and even secondary school classes.

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

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

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

Special Schools in Pakistan (1947 - 2006)

600

400

200

0 1947 1960 1970 1980 1990 200 2006

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

3.2 Institutional Arrangements

The State has an Education For All (EFA) policy that assures all children, including handicapped children, have the right to a free appropriate public education. There is, however, no established time specific goal for providing full educational opportunity to all handicapped children and a detailed road map for accomplishing such goals at all levels viz. union council, tehsil and district. Moreover, provincial operational plans describing the type and number of facilities, personnel, and services required to make possible delivery of services for disabled are currently lacking. Under the DGSE-led institutional arrangements, there is no monitoring mechanism in place to keep liaison with 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 private institutions or other care facilities that are not functioning under its administration. The devolved district governments are responsible for all educational programs including those of handicapped children and training of their teachers. Prior to the devolution of power plan 2001, at the provincial level the Social Welfare Departments (SWD) were generally responsible for assuring the requirements of Special Education (SE) including maintaining liaison with all such programmes administered by NGOs and the private sector. In Punjab, however, an independent Special Education Department (SED) was established in 2003 and is responsible for educational programmes for persons with disabilities. The Government of Punjab has established a goal of providing full educational opportunities to all handicapped children through a comprehensive system of personnel development mandated and established under the elected provincial government. The Punjab Government has established a detailed timetable for accomplishing this goal and a plan of action providing a description of the kind and number of facilities, personnel, and services necessary to meet the goal. The elected government provides satisfactory assurance as regards provision of funds.

In 1985, the Directorate General of Special Education (DGSE) formulated a draft National Policy for Special Education and revised it in 1988 to bring it in line with the emerging needs of target population. In 2002 a new National Policy for Persons with Disabilities was launched under the Ministry of Women Development, Special Education and Social Welfare. Currently, the DGSE is under the Ministry of Social Welfare and Special 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 to PWDs; 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 ensure the protection and promotion of human rights including the rights of persons with disabilities. Pakistan fully supports the recommendations of International Convention on Disability (Bangkok June, 2003) and the recommendations that were formulated in response to the invitation by the UN General Assembly in Resolution 57/229. The equality and non-discrimination with reference to persons with disabilities is considered important, as are the specific rights of persons with disabilities as spelled out in Bangkok Convention. In addition, for the monitoring mechanisms proposed in the Bangkok recommendations, Pakistan considers a need for a very strong media group, consisting of international and regional representatives to highlight the violations, if any are committed by the member states (Excerpts from Pakistan Country Paper, Bangkok 2003, Muhammad Majid Qureshi, Director, Special Education/GoP)

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

It is encouraging to observe that most of the DGSE’s appointed Directors/Principals of Federal Special Education Schools in the provinces are in touch with the mainstream provincial programmes/projects. The provincial departments and the recently devolved local government organizations and their functionaries have limited knowledge with respect to the federal policy and programmes and the emerging trends such as current thinking to integrate the free public education of all handicapped children through the mainstream educational system. Integrated education is the most recent approach adopted in the developed world for the mainstreaming of the PWDs. The purpose is both to minimize expense and help the PWDs adjust in mainstream social environments. The Government of Pakistan in its Perspective Development Plan 2001-11 (Planning Commission of Pakistan, September 2001) spells out the need for integrated education of PWDs in regular schools in all provinces. The plan states that all government schools would provide training of regular school teachers in Special Education and complimentary teaching aids and equipment for implementation of integration plan. Further an administrative mechanism at state level would be put on place to achieve the goals 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, under the supervision of Directorate General of Special Education. Brief functions of each institution are summarized below: a) National Institute of Special Education (NISE): established in 1986 develops curriculum 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 an average every year. b) National Council for Rehabilitation of Disabled Persons (NCRDP): founded in 1982 to implement and monitor the affirmative action plan for the rehabilitation and employment of disabled under 1981 ordinance for provision of 1% employment quota to the disabled. The NCRDP has a Board of Governors (BOG) represented by both public and NGO sector leadership in disability. c) National Mobility and Independence Training Centre (NMITC) for visually handicapped (VH): conducts courses on mobility and independence of VH. d) National Training Center for Special Persons (NTCSP): established in 1986 with the 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 in tailoring, typing, short hand, welding, electrical work, carpentry and a variety of other skills. Employability of trained individuals is a major problem.

e) National Special Education Centers: provide services such as assessment and diagnostics, education up to Primary, Middle, Secondary and Higher Secondary levels, pre vocational and vocational training, early intervention , physiotherapy, speech therapy , occupational therapy, indoor and outdoor recreation facilities and parents’ counselling. f) National Library & Resource Center (NLRC): established in 1986 serves as a resource center for print and audio-visual material on special education and disabilities. About 10,000 reference books are currently available. I Internet facilities are also available for professionals and researchers.

g) National Institute for Handicapped (NIH): established in 1987 as speech and hearing disorder therapy center and subsequently upgraded to a general hospital for handicapped in 1997. It has physiotherapy, orthopaedic, surgical, ENT, pathology and radiology departments serving both disabled and non-disabled patients. It has now been transferred to Ministry of Health because of its clinical nature. Recently, NIH has been renamed as National Institute for Rehabilitation Medicine with a view to achieve broad based goals. h) National Trust for the Disabled (NTD): established in 1988 under the Charitable Endowment Act, 1890 to ensure implementation and coordination of the services for diagnosis, assessment, treatment, education, job placement and rehabilitation of PWDs. NTD is an autonomous body under the administrative control of the Ministry of Social Welfare & Special Education. It has a Board of Governors (BOG) comprising senior government officials and NGO representatives in the field of disability. Currently NTD is independently 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 Lahore Chamber of Commerce an affiliate group named as Lahore Association of Businessmen for 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 education institutions in the country catering to the education and training needs of the persons with disabilities as reflected in Graph-14: Graph - 14

Disabilty Wise Distribution of Special Education Institutions

300

250

200

150

100

50

0 More Than Hearing Visually Mentally Physically Multiple One Disability Impaired Handicapped Retarded Handicapped Cases

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

It is evident from the above graph that more than half of the total institutions (276) are catering to the needs of persons with more than one disability, 95 for hearing impaired children, 54 for visually impaired children, 43 for mentally retarded, 40 for physically handicapped 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:

Graph - 15

Area/ Region Wise Distribution of Institutions (%)

Capital Area, 6.4 Northern Areas, 2.6 Balochistan, 2.3 AJK, 1.9

NWFP, 13.2

Punjab, 51.4

Sindh, 22.2

Source: Survey of Services and Facilities for Persons with Disabilities, DGSE-2006 The Punjab province ranks highest with regard to the establishment of special education 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 of institutions 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 post graduate level. 53 institutions ( 9.98%) provide training in basic skills. The number of vocational training centers comes to 26 (4.89%) and 136 centers (25.61%) provide other services.

Graph - 16 Special Education Schools/Institutions in Pakistan and Nature of Education / Training Imparted

200 180 160 140 120 100 80 60 40 20 0 Basic Middle Degree Vocational Skills

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

3.7 Administrative Control Of Special Education Institutions

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

Administrative Control of Institutions (%)

International Organizations, 2.48 Federal Gov., 12.61 Individuals, 10.54 Provincial Gov., 11.86

Semi Gov., 2.25 NGOs, 34.65 District Gov., 25.61

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

The above graph reveals that more than a third of the institutions (34.65%) are under the administrative control of the NGOs, more than one quarter (25.61%) are under the administrative control of district governments. The share of federal and provincial governments in the administrative control comes to 12.61% and 11.86%. 10.4% of institutions are under the administrative control of individuals, 2.5% under the administrative control of semi-government and 2.48% under the supervision of international organizations.

3.8 Rented And Self-Owned Buildings

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

Graph - 18 Rented and Self-owned Status of Buildings of Institutions

300 250 200 150 100 50 0 Rented Self Ow ned Source: Survey of Services and Facilities for Persons with Disabilities, DGSE-2006 3.9 Accessibility In Special Education Institutions

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

Graph - 19

Level of Access (%)

Restricted Access, 20.5

Barrier Free Access, 79.5

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 in the 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 to socio-cultural condition of the country.

Graph - 20 Gender Wise Enrollment in Special Education Institutions

18000 16000 14000 12000 10000 8000 6000 4000 2000 0 Boys Girls

Source: Survey of Services and Facilities for Persons with Disabilities, DGSE-2006 3.11 Special Education Teachrs

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

In the early days of the special education system in Pakistan, teachers were employed or assigned to teach in a field in which they were not academically certified. The situation has now improved considerably with the establishment and expansion of education and training facilities available in Allama Iqbal Open University (AIOU) Islamabad, Punjab University Special Education Department Lahore, Karachi University Special Education Department and Teachers Training Colleges established by the Special Education Department of the Punjab Government at Lahore and National Institute of Special Education, Government of Pakistan at Islamabad. The special incentives like double pay for trained Special Education Teachers have been instrumental in promoting and up-grading of the qualifications of teachers but on the other hand this has also deprived several NGOs of trained teachers who prefer to join jobs with better pay. The number of Special Education Teachers has increased over the time. The data reflected 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.

Graph - 21 Number of Male and Female Teachers

3000

2500

2000

1500

1000

500

0 Male Teachers Female Teachers Total # of Teachers

Source: Survey of Services and Facilities for Persons with Disabilities, DGSE-2006 3.12 Teacher Qualification And Training

The level of teacher training remains below the desired standard. Out of the total teachers (2,992), there are 529 teachers who possess Master’s Degrees in Special Education, 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 qualifications are not given or reported. The percentage of teachers by qualification is reflected in Graph-22 below: Graph - 22 Qualification Wise Distribution of Te aching Staff (%)

Matric, PTC, CT, 3.9 Matric Untrained, 6.4 Matric , TD, 0.7

Not Reported, 16.7 FA/F.Sc, Untrained, 5

FA/F.Sc PTC/CT, 4.2 FA/F.Sc/TD, 0.7 MA (Sp.Ed), 17.7 BA/B.Sc, Untrained, BA/B.Sc, 8.6 MA/M.Sc,TD, 1.9 PTC/CT/B.Ed/M.Ed, MA/M.Sc,PTC/CT/B.Ed 14.4 / M.Ed, 13.6 BA/B.Sc, Trained, 2.1

MA/M.Sc Untrained, 4

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

Graph-22 shows that 17.7% of total teachers possess M.A. Special Education Degree. A total of 16.7% did not report their qualifications, B.A. / B.Sc trained teachers come to 14.4% , while B.A. / B.Sc. un-trained teachers were reported to be 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 remained stagnant. While science and modern technology have made tremendous leaps in the latter half of the 20th century opening up new avenues and new horizons for the able-bodied, the disabled are still being trained in traditional crafts and for simple repetitive jobs like basketry, chair-caning, handloom weaving, , assembling, light electrical/mechanical works etc. Sadly, the opportunities for employment even in these limited fields are dwindling rapidly. Agencies and institutions for the disabled find it easier to continue to operate on traditional approaches. The number of these facilities is too meagre to meet the growing needs of the disabled population. These services are available only in big cities like Karachi, Lahore and Islamabad depriving the major portion of persons with disabilities living 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 centralized in urban areas and delivered through static vocational training institutions. They are located usually in the capital or other large cities. The number of the institutions is very small. It is estimated that today, among the PWDs in need of rehabilitation, only a small proportion have access to any vocational rehabilitation (VR) services. Moreover, most institutions provide rehabilitation only for certain types of PWDs and for certain age groups. The problem is serious for the estimated 70% of disabled population that live in rural areas. According to WHO estimate, 70 % of persons with disabilities in community need only simple training 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 the specialized services provided by rehabilitation institutions.

Efforts to increase the accessibility of services in a community setting are being pursued through community based rehabilitation (CBR) programmes both in the public and NGO sectors. Some of CBR programs are complimented with micro- credit programs. Social limitations caused by discrimination have reportedly decreased as people are becoming accustomed to business interactions with people with disabilities. Many individuals who have never worked before, or have never worked successfully, are able to function well in competitive employment with 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 to the present. Documented histories of the Indian sub-continent provide evidence that disabled people played various roles in their families and communities, sometimes with a good deal of independence. Yet some evidence challenges stereotypes and suggests that disability historically evoked a wiser range of responses and initiatives. The practices and motivations of philanthropists, and the worthiness or unworthiness of recipients, were subjected to critical discussion in Hindu, Jain, Buddhist and Muslim histories. Formal community-based rehabilitation development in the 21st century could become more appropriate and effective by studying the previous decades of cultural experience. While many possibilities exist for enlisting local human resources in developing South Asian societies in which disabled people can live better lives, the most durable solutions are likely to have long roots in the cultures and perceptions of the people and their communal histories. Villages are the focal points of CBR programmes of the Association for the Rehabilitation of the Physically Disabled (ARPD), NWFP Pakistan. The bulk of the rural population here is engaged in agriculture, rural trades, indigenous crafts, farming, including animal husbandry. Rural families are normally large; three or four generations live and work together to survive in a labour-intensive agro- based economy. The CBR approach envisages a similar partnership between PWDs and the rest of the community for its socio-economic development. ARDP has established a network system in the community among PWDs, support service providers and policy makers at the provincial and national levels. Presently ARDP has established 61 CBR centres by networking with 300 partner organizations in 100 towns of the country . The concept of the rights and duties of PWDs to participate individually and collectively in the planning and implementation of services is exemplified in this community-based approach.

One CBR group in the public sector in Pakistan is the Islamabad-based Vocational Rehabilitation of Disabled Persons (VREDP) that has assisted 500 disabled 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 small businesses. The loan recovery rate is reportedly 99%. The VREDP has also been able to find jobs for the PWDs. Over the year, it helped find jobs for some 200 disabled who had been suitably trained, in factories around Lahore with the help of the Lahore Chambers of Commerce and Industry (LCCI) and Lahore Association of Businessmen for Disabled (LABAD).

3.15 Medical Rehabilitation

Providing timely and effective medical rehabilitation services for persons with disabilities affected by disease, injury or congenital impairment can contribute materially to their subsequent health, independence and personal productivity. In the aggregate, therefore, medical rehabilitation services are a powerful means of combating disability.

In Pakistan, well-documented descriptions of medical rehabilitation services are lacking from available literature and databases. Generally, most medical rehabilitation practices on the part of physicians, surgeons and nurses have been developed during the course of service provision rather than as part of a formal training. Medical rehabilitation programmes provided at the National Institute for Handicapped (now renamed National Institute for Rehabilitation Medicine) are not exclusively dedicated for the handicapped. NIH could not convincingly fit into the macro model of disability. Over 60% patients attending the NIH do not meet disabled classification. Earlier emphasis was upon assessment, diagnosis and therapeutic services. This paradigm has recently shifted to rehabilitation component.

The Mayo Hospital Lahore on the other hand provides a model that promotes interdisciplinary interaction in medical rehabilitation education, training and research. The Department of Medical Rehabilitation is one a kind in the country wherein the emphasised areas are improving functional mobility; promoting behavioural adaptation to functional losses, developing indigenous orthotics and prosthetic technology; and training under-graduates and post-graduates in the medical rehabilitation field. Among the range of devices currently manufactured at Mayo Hospital include artificial limbs, appliances, and body support and mobility systems. In prosthetics and orthotics, modular preparation using local components and better understanding of gait and pressure distribution and higher standard of fitting and design are maintained.

Overall, medical rehabilitation and the mainstream service delivery system of which 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 preferences are not uniformly applicable to a variety of present day services and systems of care. In this regard, it is worth mentioning that existing services of the Army Medical Corps (AMC) can be said to be at the greatest advantage in terms of knowledge of medical rehabilitation, outcomes, interventions and service delivery systems.

The provision of appropriate training in the field of medical rehabilitation is extremely deficient. Service providers at district, tehsil and union council level lack well-substantiated guidelines on patient management pivotal for the field. Medical rehabilitation of the disabled generally is perceived to have low priority in 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 responsibility depends on the availability of funds and order of priority as envisaged by the elected district governments.

Physiotherapy is an important medical rehabilitation service for the disabled. An underlying constraint in the country is the shortage of physiotherapists and their concentration in cities where salaries and work conditions are better than rural areas. The hospital-based physiotherapists in large cities tend to not provide services beyond the walls of the hospitals unless it is regarded as private practice after official work hours. Home exercises are often included in treatment programmes but there is no way of ensuring that patients carry them out effectively. Rural areas with nearly three-quarters of the population are largely neglected. Patients with acute pain in the lower back or with cervical spondilysis have to travel in uncomfortable buses to the cities for treatment. PWDs needing long-term management, such as paraplegics and hemiplegics, are often unable to undertake such journeys; hence a majority of them opt for local treatment through traditional healers in their own localities. SECTION 4: LEGISLATION AND POLICY REFORMS

This section covers the statutory measures taken by the Government and policy reforms 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 promulgated by the Government of Pakistan during the International Year for Disabled (IYDP) in 1981 to provide a legislative support to persons with disabilities ensuring employment opportunities to them in open market including government departments, commercial establishments and industrial concerns. The law prescribes a quota of one percent for compulsory employment of PWDs which was subsequently raised to two percent by executive order. The disabled person employed under this quota is entitled to all the terms and conditions which will in no way be less favourable to other persons employed in that establishment.

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

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

PWDs desirous of being employed have to get themselves registered as disabled persons 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 disability assessment carried out by a Medical Board established at district levels under the Chairmanship of Medical Superintendents of DHQ Hospitals on the parameters laid down in the ordinance.

The Ordinance provides for the establishment of a fund known as Disabled Persons Rehabilitation Fund consisting of all sums paid by establishments, grants made by Federal Government, Provincial Governments, Local Bodies and donations received from individuals. The amount collected has been insufficient to 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 lengthy consultative process involving all stakeholders and relevant Federal Ministries including Health, Labour Manpower, Housing and Works, Science and Technology as well as relevant departments and prominent NGOs.

The policy acknowledges the need for the provision of a comprehensive range of facilities for persons with disabilities from prenatal to postnatal period through proper assessment education, vocational training and employment. The provision and expansion of services of good quality require a multi-sectoral and multi- dimensional approach. This is possible only through the active cooperation of federal, provincial, local government organizations, NGOs as well as involvement of family, professionals and the community at large. The policy document contains a vision, guiding principles and strategies to achieve the objectives. The overall vision of the policy is to provide a conducive environment for the realization of the full potential of persons with disabilities leading to their empowerment irrespective of , creed, colour race, or religion in all spheres of life 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 the National Policy for the Persons with Disabilities 2002. The NPA is based on the philosophy that access, inclusion and equalization of opportunities for the person with disabilities are not possible by isolated interventions. These services should therefore be designed in an integrated way by pooling and mobilizing all resources. The NPA identifies 17 critical areas of intervention from assessment of the magnitude of the problem to service delivery systems. It spells out short term steps to be taken by the end of June 2009 and long term measures to be adopted by July, 2025. It contains specific time frames for the completion of each activity and assigns responsibility to various departments and agencies. The short term measures 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 secondary preventive 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; and boosting up public opinion and increasing support to NGOs.

The long term objectives reflected in NPA focus on creation of barrier free physical environment for PWDs in all public, private and commercial buildings and public places and revision of construction bye laws. More effective enforcement and expansion of social assistance and social security programme under 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 of disability that limits their ability to move around in their surroundings. Unless these people are capable of moving around in, and using their environments, the dream of their full participation and equality within society cannot be realized. To achieve this goal, building by-laws and codes have been formulated and enforced, making it mandatory upon owners, designers, builders and regulators of public buildings and facilities that all new construction meant for public use be made in such a way it is without physical barriers and that already existing buildings and facilities are modified to an achievable extent. The accessibility code prepared by the DGSE prescribes minimum legal requirements and regulations for building enclosures and systems, its compliance in terms of space and material provisions can be achieved in scores of ways.

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

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 the premises from parking place; site or entrance; and / or public street to accessible entrance to the building; ii. A gradient of less than 1:20 is considered level access; and iii. 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 inches from 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 be accessible by a wheelchair bound person; and ii. The entrance into the building shall give a clear opening of not less than 33 inches.

4.4.3 Ramped Approach

i. Where ramps are required to manoeuvre a distance along an accessible route, the running slope should not exceed 1:20, and in any case shall not be 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; and v. 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 36 inches wide; ii. Each step shall have a riser not more than 6 inches and a tread width of not less than 11 inches; iii. Single steps should be avoided; and iv. 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 limited to, ramps and steps shall be of a firm, slip-resistant and reasonably smooth construction especially under wet conditions; and ii. Detectable tactile surface should be provided across the width of accessible route at each level change and at head and foot of ramps and steps.

4.4.6 Handrails

i. To provide guidance and support continuous handrails should be provided along exposed sides of the accessible route; ii. The handrails shall be of sturdy construction, not exceeding 2 inches in diameter and shall extend a minimum of 12 inches beyond the step or ramp in the running direction; and iii. The height of the handrail from the floor surface shall not be less than 30 inches and more than 42 inches. 4.4.7 Walkways

i. To allow for wheelchair users the walkways, footpaths and sidewalk pavements shall not be less than 48 inches wide; and of a clear width of 36 inches at clearly identified obstruction like utility poles, trees and other appurtenances; ii. The gradient of walkways should not exceed 1:12; iii. All walkways shall have curb ramps conforming to ramp specifications at curb crossings; and iv. 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 not larger than 1 inch width.

4.4.8 Pedestrian Crossings

i. All marked pedestrian crossings on the roads shall be provided with curb ramps and detectable floor paving; ii. The pedestrian crossings shall be clear of obstructions along the road width and should have guiding rails at the curbs; iii. Where possible auditory signals and manually operated traffic lights should be provided at road crossings in areas of high pedestrian traffic; and iv. Safe traffic islands to reduce the length of the crossing are recommended for the safety of all road users.

4.4.9 Vehicular Parking

i. Parking facilities shall be accessible through an accessible route and at least one floor of a multi-story indoor parking facility shall be served either by an accessible elevator or an accessible ramp; ii. For car parking places requiring a minimum of twenty and maximum of fifty parking spaces at least one dedicated parking space shall be reserved for the exclusive use of drivers or passengers with physical disabilities; iii. Where car parking requirements exceeds fifty spaces in number, a minimum of two percent of parking spaces shall be so reserved; iv. For motorcycle and bicycle parking places requiring a combined minimum total of at least fifty spaces, one parking space for adapted tricycle or motorcycle meant for the use of persons with physical disabilities shall be reserved; v. Where bicycle and motorcycle parking requirements exceed fifty, a minimum of four percent of parking spaces shall be so reserved; and vi. The reserved parking spaces shall be located in clear view of and nearest to 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 be less than 12 feet, inclusive of a 48inches wide accessible aisle; ii. A 48 inches wide access aisle may be shared between two adjacent car parking 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 parking shall be maintained as 8 feet; and v. All parking spaces reserved for the use of drivers or passengers with disabilities shall be clearly identified on the ground surface with internationally accepted markings.

4.4.11 Public

i. Public toilets in outdoor facilities and along public streets should be provided at convenient locations and preferably in close proximity to mosques and public parks; ii. Each location of public toilets shall have at least one unisex for use by persons with disabilities; iii. The unisex shall be accessible and usable by persons with disabilities of either gender and shall be equipped with usable hand basin, European type water closet, grab bars, running water, and workable illumination; and shall be large enough to accommodate one wheelchair bound person accompanied by an attendant of either gender; and iv. The shall be identified with accessibility signs for visual and tactile identification. SECTION 5: MAJOR CHALLENGES AND CONSTRAINTS

The identification of challenges faced by persons with disabilities and organizations working for their welfare is of paramount importance. This important aspect has remained neglected in the past. No scientific study or survey at national level was ever conducted to comprehensively asses the problems of this marginalized segment of the society. However, inferences or conclusions drawn from the various micro studies carried out from time identify the following challenges and constraints which were also duly endorsed, as well as refined, by various 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 for the welfare, rehabilitation and socio-economic uplift of persons with disabilities but no national level network exists to provide them a platform to undertake greater advocacy and make themselves more visible to key stakeholders. Even a common web-site does not exist whereby persons with disabilities and others can know 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 and are not aware of the full range of facilities and services offered by various organizations. This keeps them marginalized and detached from the rest of society.

5.2 Lack of Reliable Data

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

5.3 Inappropriate Need Assessment

The ownership of any programme largely depends upon the common needs of the beneficiaries and key stakeholders. However, in Pakistan no scientific effort has been 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 with Disabilities. However, the present government plans to do so at the earliest.

The Disabled Persons (Employment and Rehabilitation) Ordinance 1981 does not contain an effective mechanism for the employment and rehabilitation of PWDs due to number of lacunae in the Ordinance. The amended Ordinance under consideration of the Government is yet to be approved.

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

5.5 Lack of Community Based Programmes

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

The role of media in changing society’s view of disability and disabled people is vital but there is no tangible communication between the media and organizations serving and representing the rights of persons with disabilities.. The important issues facing people with disabilities in Pakistani society include the perceptions by the society that disabled people deserve segregated educational facilities and exclusion from regular educational system. Hence “inclusive education” for persons 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 has improved considerably in big cities like Lahore, Karachi and Islamabad with the establishment of training institutes including Departments of Special Education in Punjab University, Karachi University and AIOU Islamabad. But the institutions established at other places mostly lack trained and qualified teachers.

Similarly there is an acute shortage of allied technical staff in the existing institutions which include audiologists, speech therapists, physiotherapists and occupational therapists. 5.7 Inadequate Resources

Social Welfare & Special Education” has been an integral part of development planning in Pakistan but this sector has always remained at the lowest priority in resource allocations (except for a few years in the early 1980s). The development budget allocated to the Federal Ministry of Social Welfare & Special Education during 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 the efforts 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 meaning NGOs working for PWDs struggle to maintain financial sustainability.

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

5.8 Inadequate Services and Facilities

The number of existing services and facilities for PWDs are absolutely insufficient and in no way correspond to the number of PWDs. The availability of only 531 institutions in the country for the disabled population of 3.29 million is almost negligible. More notably the following inadequacies are worth being highlighted:

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

Paucity of Vocational Training Facilities / Services: Vocational training plays a significant role in making the PWDs productive members of the society. There is a great scarcity of vocational training facilities in the country. The vocational training being imparted is restricted only to stereo type traditional trades like cane work, weaving, candle making, lace making that hardly respond to the demands of the contemporary market; Environmental barriers: Most of the public places in our cities, including government offices, schools, colleges, shopping malls and restaurants etc. do not provide a “barrier free” environment to PWDs. These buildings do not have support rails, ramps or lifts to facilitate the PWDs. Even in buildings where there are lifts, the press buttons are beyond the reach of wheel chair users. There are no specific seats reserved in public buses for the PWDs. Most of the buildings of even the special education institutions are not well suited to peculiar needs of the PWDs.

Lack of workshops: There is serious lack of proper workshops and equipment in the country. For example, physiotherapy equipment available in most of the centers has become obsolete and needs replacement. Similarly, ortho- prosthetic workshops are available in big cities only which are hardly accessible to the population living in far flung rural areas. Integrated workshops are virtually non existent whereas these are imperative for the main streaming of persons with disabilities. There are no shelter workshops in the country where totally incapacitated persons could be provided some level of 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 with disabilities may be established to provide a neutral but powerful forum for those engaged in the welfare of PWDs. This network should be open to all organizations working for PWDs, irrespective of their location, size and nature of programme as long as they work for the larger good of PWDs. This network could provide much needed services such as development of various data bases, creation of a mega web-site, lobbying and advocacy and creating greater awareness among key stakeholders. It will also facilitate the PWDs by providing them information and access to the services and facilities provided by both the government and the civil society.

6.2 Collection of Reliable Data

The non-availability of reliable data is a great impediment in the effective delivery of services to PWDs. Database provides a basis for policy making, project planning and programme implementation. There is a vital need to have reliable data about magnitude of the disability problem in Pakistan. It is, therefore, imperative that a comprehensive survey to determine the status of disability be carried out which should also focus on the need assessment of PWDs to 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 launch programmes 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 on the Rights of Persons with Disabilities so that it is part of the global efforts to improve the quality of life of PWDs.

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

Weak enforcement mechanisms need to be strengthened so that the benefits available to PWDs, such as 2% quota in jobs, can accrue to them. This requires advocacy 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 in large cities and delivered through static vocational institutions. The number of institutions offering such programmes is very small, and the problem is more serious for the disabled population living in rural areas. Villages, therefore, should be the focal point of community rehabilitation programmes through a network of civil society and community based organizations at the grass-root level. Association for the Rehabilitation of Physically Disabled (ARPD), NWFP present a good model that can be replicated in other rural areas.

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

Contemporary shifts in models of social development call for the promotion of participatory development to create and strengthen ownership, minimize the cost of delivery of services and to ensure sustainability of programmes for PWDs. The future strategy should, therefore, be directed towards initiating Public-Private Partnerships between government and CSOs. This will help in mobilizing community resources for filling the resource gap. The possibilities of adopting special education institutions by the corporate sector may also be explored to share the burden of government.

6.6 Human Resource Development

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

Distance learning programmes need to be launched in the rural areas to create a cadre of social activists and workers focused on this vital sector. Formal education system, particularly the teacher education programmes, needs to integrate “special education” into their curricula to create more awareness among teachers in the formal education sector. 6.7 Resource Mobilization

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

Training PWDs in agro-based trades can also help them in becoming self reliant members of the society. Majority of disabled population live in rural areas with no access to credit. Financial support should be provided to PWDs, through Zarai Taraqiati Bank, Khushali Bank NRSP, and RSPs who have their network at district level and rural areas. The funds may be provided for starting small business like bee-keeping, poultry, fish-farms, diary development and other agro based income generating trades.

The possibilities of establishing a National Finance and Development Corporation for PWDs, on the pattern of a similar organization in India, needs to be considered seriously.

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

6.8 Provision of Suitable Facilities and Services

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

Better vocational education facilities: Vocational education programmes need not only to be expanded but their curricula needs to be in line with contemporary market requirements; Improved accessibility: All public buildings and facilities need to have “barrier free” environment for PWDs. This requires a mass awareness campaign as well as early approval and enforcement of the Building Code drafted by the Government to increase access in buildings;

Better workshops: Sheltered workshops required for severely handicapped persons are almost non-existent in Pakistan. A few such projects may be established in bigger cities to provide opportunities of supportive employment for PWDs. Similarly, few ortho-prosthetic workshops exist both in the public and private sectors which are inadequate to cater to the growing needs of the PWDs. Such workshops, with trained technicians and qualified staff, should be created at district level.

Industrialization and urbanization has resulted in the breakdown of our traditional joint family system which poses new problems particularly to PWDs, since there is no one to look after them at home. The totally incapacitated children and elderly persons are leading miserable lives. Even the few homes established by Edhi Foundation do not have the desired arrangements backed by trained nurses, para-medics and technicians. The establishment of well equipped and properly staffed homes for the totally incapacitated is strongly recommended; Annexure I Recommendations of the Focus 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 at national level for undertaking advocacy and giving their advise in planning and execution of programmes relating to persons with disabilities; and

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

Awareness Raising/Information Sharing

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

Outstanding achievements made by persons with disabilities need to be highlighted through 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 and organizations working for them may be created (e.g. development of a one stop web-site);

Community Based Programmes

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

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

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

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

Facilities

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

Promotion of research on issues of persons with disabilities by public and private sector organizations should be encouraged. Annexure II Recommendations of the Focus |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 ensuring effective referral services keeping in view the peculiar needs of the PWDs.

Awareness Raising/Information Sharing

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 mass motivation, advocacy and disability sensitization to wash out the stigma attached to the disability;

Print and electronic media should be sensitized to project the abilities and potentialities 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:, levels to 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 cost effective 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 inclusive education could be started with due care and caution after sensitizing the parents, teachers, students and communities and with the provision of essential equipment where needed (an example of 1300 schools in Punjab was given where inclusive education 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 the amended law which had been under considerations of the standing committees of National Assembly and Senate may be expedited and got passed from the parliament;

Great concern was shown on the poor preference of the National Trust for the Disabled Persons which has utilized its corpus on the construction of Directorate General of Special Education buildings. The similar trust established at Punjab had increased 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 was also considered to be much below the desired standard that warranted its revitalization; and

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

Facilities

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

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

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

Establishment of homes for the incapacitated persons/children was considered to be essential 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 of disability 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 sale of their product was a big problem that required the establishment of display centers for the sale of their products. The existing dichotomous salary structure emerging from the double salary package given to the special education teachers by government of Punjab was likely to result in brain drain because majority of the NGOs 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 the Focus 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 with disabilities;

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

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

Awareness Raising/Information Sharing

Social awareness campaigns should be started through T.V. and Radio about the problems and causes of disabilities as was largely being done in case of , 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 creating mass awareness;

Parents counselling and guidance programme should be started;

Comprehensive Performa may be designed for collection of data about the disability during 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 to the Curriculum Wing of Ministry of Education, Islamabad which should be pursued vigorously;

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

Refresher training courses for the existing teachers of special education centers may be organized; Indigenous teaching material in local or regional languages should be prepared for public instructions through schools and mosques;

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

Basic training to the LHVs, Traditional Birth Attendants (TBAs) and Mid-wives should 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 be used as focal points.

Inclusive Education

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

Enforcement

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

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 measures to avoid it in children; and

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

Facilities

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

It was stressed that there were about 21 genetically transmitted diseases that could be averted if the blood test was made mandatory before marriage through an act of the parliament. 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 it was essential that special education programme should be expanded and extended in rural areas to reach the un-reached; The procedure of getting railway concession for visually handicapped persons should be simplified and made available at all railway stations instead of only at commercial offices of railway located at Karachi and other big cities;

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

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 causing disability during prenatal care and delivery procedure. The establishment or continence of MCH centers without qualified LHVs and medical staff should be discouraged / 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 Recommendations of 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 paradigm shift from medical rehabilitation to socio-economic / community based rehabilitation that required the highlighting of community based rehabilitation programme – (the consultants replied that this was done in the report but not fully highlighted in the presentation)’

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

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

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

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

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

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

The participants highlighted various other issue and possible remedies. Salient points of their 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 and duplication and ensuring optimum use of meagre resources; and

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

Awareness Raising/Information Sharing

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

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

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

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

It was observed that there were about 50 private channels. The possibility of asking them to donate 5 minutes time free of cost may be explored to solve the problem of mass 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 education although it was agreed that the goal of Education for All (EFA) could not be achieved without inclusive education.;

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

It was informed that the Punjab Government had already established Special Education Centres at tehsil level and was planning to extend the services to Union Council level; It was pointed out that out of 700, 000 school age children with various disabilities only 30, 000 were in the schools that constituted only 4% of the children of school going group that necessitated the introduction of inclusive education; and

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

Enforcement

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

It was clarified that there was a difference between signing and ratifying the convention. 120 countries of the world had signed this particular UN Convention while 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 with the UN Convention on the Right of PWDs;

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

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

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

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

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

The participants desired that Aga Khan Foundation may look into the possibility of establishing 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 in Hunza on a plot donated by the locals;

The data regarding the number of disabled persons employed against 2% quota could be ascertained from the NCRDP and amount collected in lieu of recruitment from NTD, 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 a comprehensive questionnaire for the national survey on disability, which would be finalized 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 sports competitions and securing third and sixth position in the CSS examination during the last 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 greatly stressed;

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

The prose and cons of producing Braille books at the national and provincial level were 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 V LIST OF PARTICIPANTS

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

S. No Name Organization / Address 01. 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, Peshawar 03. Syed Shahid Akram Special Education Complex, MRC, Peshawar, M/o SW&SE, Govt. of Pakistan, Phase-V, Hayatabad, Peshawar. 04. Ms. M. Raheel Special Life Foundation Shireen Flat # 2nd, 3rd Floor, Silicon Center, University Road Peshawar. 05. Mr. Arbab Khan Social Welfare and Special Education Department, Govt. of Pakistan, Khyber Special Education Center for Hearing Impaired 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 Akram Special Education Center for Visually Handicapped Children, Shah 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 Development Department, 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, Dubgari Gardens, Peshawar Cantt. 12. Mr. Muhammad Social Welfare Department, Govt. of NWFP, Bashir Opp. Islamia College, Jamrud Road, Peshawar 13. Mr. Ikramullah Special Persons Development Association (SPDA), Daudzai 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 Ali Anjuman-e-Naujawanan, Rabbani 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. Shakeela Center for Speech and Hearing, Farooq Sector-A, Street-01, Sheikh Maltoon, Mardan 19. Ms. Sadia Jabeen Gender Analyst, Zakat, Ushr, Social Welfare & Women Development 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 Sohail SAHARA Voluntary Social Welfare Agency for PWDs, Saddozai SAHARA Square, Near District Courts, GPO Box-01, Dera Ismail Khan 22. Ms. Lubna Riaz Zakat, Ushar, Social Welfare and Women Development Department, Benevolent Fund Building, Peshawar 23. Ms. Sumbal Sheikh Zakat, Ushar, Social Welfare and Women Development Department, Benevolent Fund Building, Peshawar 24. Ms. Sana Amin Zakat, Ushar, Social Welfare and Women Development Department, Benevolent Fund Building, Peshawar 25. Mr. Muhammad National Council of Social Welfare, Govt. of Pakistan, Nawaz 3-D Plaza, G-7 Markaz, Islamabad ORGANISORS 26. Gul Najam Jamy Programme Manager, CSP, Aga Khan Foundation (Pakistan), Islamabad 27. Malik Mumtaz Consultant, Islamabad Hussain 28. Mukhtar Ahmad Consultant, Islamabad 29. Syed Izhar Hussain Consultant, Islamabad Annexure VI LIST OF PARTICIPANTS

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

S.No Name of Participant Organization / Address 01. Mr. Irshad Waheed Social Welfare, Women Development & Bait –ul-Mall, 41- Empress Road, Lahore. 02. Mrs. Aqeela Ashfaq Al Qasim Institute for MRC, IslamPura, Sahibzada Jehlum. 03. Mr. Afzaal Humayon Voice of Specials, E-99, Fateh Abad Colony, Lahore Cantt. 04. Mr. Azhar Sajjad F.G Hajwairy Special education Centre for visually impaired children ,45-B Johar Town, 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, Special Education Department, 31-Sher Shah Block, Garden Town, Lahore 09. Mohammad Fazil Special Education Department, 31-Sher cheema Shah Block, Garden Town, Lahore 10. Mrs. Rahila Farooq Institute for Disadvantaged Children Fountain House, 37 Lower Mall, Lahore. 11. Mrs. Afifa Iftikhar Government In service Trg College for the Teacher of Disabled, 31-Shere Block, New Garden, Lahore 12. Mr. Justice (R)Aamer 54-A, Block 5 Gulberg 3, Lahore Raza 13. Mr. Muhammad Aziz Jehan Begum Trust for the Blind, Salahuddin Jeddy 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 of Mentally Retarded Children, Amin Maktib, 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 the Blind 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 National Management College (Senior Arshad Management Wing) NMC Hostel, 70-B Railway Burt Colony, Lahore 22. Mr. Sohail Qadeer National Management College(Service Siddique Management Wing) NMC Hostel, Lahore 23. Dr. Mohammad Member, Planning & Development Board, Jehanzeb Khan Civil Secretariat, Lahore 24. Dr. Abdul Hameed Ex. Chairman, Department of Special Education, University of Punjab, 280 Qayyum Block, Mustafa Town, Lahore 25. Mr. Waqar Ahmad Social Welfare, Women Development & Awan Bait-ul-Mall, Social Welfare Complex Town Ship, Lahore 26. Mr. Ismail Mahmood Home for Disabled Social Welfare Qurashi Training Complex, Near Umar Chowk, Lahore 27. Mr. Parvez Masud Pakistan Society for Rehabilitation of Disabled, 578-G.G. Defense /III Feroz Pur Road Lahore. 28. Mrs. Parveen Umar Pakistan Society for Rehabilitation of Disabled, 578-G.G. Defence /III Feroz Pur Road Lahore. 29. Mr. Mohammad Zafar Shalimar Special Education Higher Iqbal Secondary School 45-B-II M.A Johar Town Lahore 30. Mrs. Farzana Javed M/o Social Welfare & Special Education Directorate General of Special Education, 45-B –II.M.A Johar Town, Lahore 31. Mrs. Samina Saleem Government Central High School for Deaf 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, Empress Road, 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, Nigehban Centre Behind Los Feroz Pur Road, Lahore ORGANISORS 37. Gul Najam Jamy Programme Manager, CSP, Aga Khan Foundation (Pakistan), Islamabad 38. Malik Mumtaz Hussain Consultant, Islamabad 39. Mukhtar Ahmad Consultant, Islamabad 40. Syed Izhar Hussain Consultant, Islamabad Annexure VII LIST OF PARTICIPANTS Focus Group Discussion held at Karachi (April 8, 2008)

S. No Name of participant Organization / Address 01. Mr. Manzoor Hussain Bhutto Education Department DEWA Academy DEWA Academy Karachi Residential , C-41, Shahbaz Town, P/O Bhittai Nagar, Hyderabad 02. Mr. Rizwan Ahmed Lodhi DEWA Trust DEWA Complex, St # 9, Block – 3 Gulshan –e- Iqbal Karachi

03. Mr. Muhammad Hanif Pakistan Eye Bank Society 14/B, St # 17/9, Near Nagar Chorangi, Karachi 04. Mrs. Farhat Swaleh Al- Shifa Karachi Airport Terminal 2 Road Airport 05. Dr. Mahmood Raza Institute of Special Children 80-B/E Block-5, Satellite Town Quetta 06. Mr. Shahid Ahmed Memon Pakisan Disabled Foundation Block 14, Naseerabad, Behind Soneri Bank , F.B. Area Karachi 07. Ms. Zainab Meher Hasan Association for Children with Emotional Learning Problems (ACBLP) 197/8 Rafiqui Shaheed Road Opposite Sindh Medical College Karachi 08. Mrs. Yasmeen Akbani Association for Children with Emotional and Learning Problems 197/8 Rafiqui Shaheed Road Opposite JPMC, Karachi 09. Mrs. Qudsia Khan Ida Rieu School and College for Blind and Deaf Near Old Exhibition Nizami Road Opposite M.A Jinnah Road Karachi 10. Mrs. Naseem Sadiq IDA RIEU School & College Ida Rien School for Deaf & Blind Nizami Road Karachi 11. Ms. Zehra Jamal Special Education Govt. of Pakistan 31 St Block 15 Gulshan –e- Johar Karachi 12. Mr. Riaz Fatima Social Welfare Department Govt of Sindh S.T. 4, Block-7 Gulshan-e- Iqbal Karachi 13. Mrs. Shahzadi Baloch Social Welfare Department S.T Gulshan-e- Iqbal Karachi 14. Mr. Abdul Khalique Solangi Qaideen Special Education Centre Block-15 St. 31 Special Education Complex Gulistan-e- Johar Karachi 15. Mr. Muhammad Aslam Shaheed-e- Millat Special Education Center for Ismail Visually Handicapped Children St. 31, Block-15, (Special Complex) Gulstani –e- Johar, Karachi 16. Mrs. Shagufta Shahzadi Department of Special Education Sheikh Zayed Islamic Centre University of Karachi 17. Mr. Muhammad Aftab Khan Govt of Pakistan National Council of Social Welfare, Islamabad 18. Mrs. Naureen Bashir Social Case Worker Quaiden Secretariat / MRC Karachi St-31 Block 15, Gulistan-e- Johar Karachi 19. Mr. Nizamuddin Social Welfare Department Block-79, Sindh Secretariat Opposite M.P.A Hostel Karachi 20. Mrs. Kishwar Sultana Directorate General of Special Education Siddique St. 31, Block-15, Gulistan-e- Johar, Karachi 21. Mrs. Mariam Ibrahim Social Welfare Department R, 85, Salman Garden Malir Karachi 22. Mrs. Mumtaz Qurashi P.C.R.D.P Social Welfare Department Govt of Sindh. 23. Mr. Sunil Kumar Directorate General of Special Education Gulshan-e- Johar Block 15 St.31- Karachi 24. Mrs. Musarrat Jehan Quaideen Special Education for MRC Karachi 31 Street Block 15 Gulistan-e- Johar Karachi 25. Mrs. Shaheena Begum (Special Education Centre for Hearing Impaired Children St. 31-Block – 15, Gulistan-e- Johar, Karachi 26. Mrs. Sabiha Haider Quaideen Special Education Centre for Mentally Retarded Children, Karachi Off. St. 31-Block 15, Gulistan-e- Johar Karachi 27. Mrs. Shabana Tabassum Special Education Centre Karachi St 31-Block 15 Gulistan-e- Johar Karachi 28. Mr. Muhammad Ashrafi Special Education (V.R.E.D.P) St. 31Block – 15 Special Education Complex Gulistan-e- Johar Karachi 29. Mrs. Ratna Deewan Quaideen Special Education for MRC Karachi Block 15, St. 31 Gulistan-e- Johar Karachi 30. Mr. Azhar Mahmood Directorate General of Special Education Special Education Complex, Gulistan-e- Johar, Karachi

ORGANISORS 31. Gul Najam Jamy Programme Manager, CSP, Aga Khan Foundation (Pakistan), Islamabad 32. Malik Mumtaz Hussain Consultant, Islamabad 33. Mukhtar Ahmad Consultant, Islamabad 34. Syed Izhar Hussain Consultant, Islamabad Annexure VIII LIST 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-8 Markaz, Islamabad. 02. Ms. Abia Akram Handicap International House # 137-B St # 43 F. 10/4, Islamabad 03. Mrs. Pakeeza Musarrat STEP House # 35-C St. # 30 G6/2, Islamabad 04. Mr. Muhammad Ishtiaq Society for the Mentally Handicapped Children Rattu 20-B Satellite Town, Rawalpindi 05. S. M Husnain Gillani Ibteda Foundation Vision Public School System P.D-1067 St. # 2 Pindi Stadium Road, Rawalpindi 06. Mrs. Farhat Sultana National Council of Social Welfare 3-D Plaza Sitara Market G-7 Markaz, Islamabad 07. Mr. Nasir Mehmood Dar Sir Syed Deaf Association 12-D, SNC Suite # 5+6 Fazl-e- Haq, Blue Area, Islamabad 08. Mr. Sohail Farooq Sir Syed Deaf Association 12-D, SNC Centre Suite # 5+6 Fazl-e- Haq, Blue Area, Islamabad 09. Dr. Fayaz Ahmed Bhatti V.R.E.D.P Directorate General of Special Education, Islamabad 10. Mr. Sultan Mehmood Govt. Qandeel Secondary School for the Blind Mirza Kohati Bazar, Rawalpindi 11. Dr. Maryam Mallick WHO WHO Office Park Road NIH Chak Shahzad, Islamabad 12. Mrs. Gulnaz Sultana Umeed-e- Noor F 8/3 House # 7 St. # 72 Islamabad 13. Dr. Imam Yar Baig Hashoo Foundation, Islamabad

14. Mrs. Naeema Bushra National Institute of Special Education Malik Plot # 74 H- 8-4, Islamabad 15. Mrs. Naila Iqbal National Special Education Centre for Mentally Retarded Children St # 7, H-8/4. Opposite Alcatel Islamabad 16. Miss Hafsa Zarrar Sipra National Special Education Centre for Mentally Retarded Children St # 7, House 814 Islamabad 17. Mrs. Shahida Mumtaz Special Education National Special Education Centre for (HIC) Islamabad H-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 Education Meharabad, Peshawar Road Rawalpindi 20. Mrs. Naghmana Jabeen D.G.S.E Min of Special Education Al- 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 REDO REDO Medical Complex I Murree Road Rawalpindi 23. Capt.( R) Maqbool Pakistan Foundation Fighting Blindness & Rawalpindi Ahmed Eye Donors Organization Ramzan Plaza g-9 Markaz Islamabad REDO Behind Naz Cinema Murree Road Rawalpindi 24. Mr.Muhammad Ilyas Azad Kashmir Association of the Blind / AKAB Ayoub School for the Blind Mirpur Flat # 4 Shehzad Plaza Opposite Pilot Boys High School # 2Mirpur AJK 25. Miss Basharat Zaman Azad Kashmir Association for the Blind Flat # 4, Shehzad Plaza Opposite Pilot High School for Boys Mirpur AJK 26. Mr. Muhammad Akhtar Sir Syed Academy (Special Education) Rawalpindi Cantt 27. Mr. Muhammad Abbas Azad Kashmir Association of the Blind Ayoub Flat # 4 Shehzad Plaza Opposite Boys Piolot High School # 2 Mirpur AJK 28. Mr. Hakim Din Ministry of Social Welfare Islamabad 29. Mr. Khalid Naeem DG, Directorate General of Special Education Opposite Noori Hospital, Islamabad

ORGANISORS 30. Gul Najam Jamy Programme Manager, CSP, Aga Khan Foundation (Pakistan), Islamabad 31. Malik Mumtaz Hussain Consultant, Islamabad 32. Mukhtar Ahmad Consultant, Islamabad 33. Syed Izhar Hussain Consultant, Islamabad Annexure IX REFERENCES

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 of Special Education, Government of Pakistan. 3 National Plan of Action for the Persons with Disabilities, 2006; Directorate General of Special Education, Government of Pakistan. 4 Survey of Facilities and Services for Persons with Disabilities, 2006; Directorate General 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 Special Education, 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 of India. 9 Study of the Educational Environments for Students with Physical Disabilities in General Education, October,2003; Ghulam Nabi Shakir (submitted in partial fulfilment of the requirements for the Degree of Doctor of Philosophy in Education at the Institute of 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 Cooperation Agency (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 with Disabilities and its Optional Protocol, 2007; United Nations. 14 The UN Convention on the Rights of Persons with Disabilities and it’s Optional Protocol; 2007 15 International Classification of Functioning, Disability and Health (WHO/ World Health 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] Web: www.nowpdp.org