Uganda and Disability
World Health Organization estimates that approximately 10% of any population is disabled. It also estimates that of the 10% only 5.8% of persons with disabilities need to be provided with services.
The United Nations Standard Rules on Equalization of Opportunities for PWDs (1991) urges all nations to show strong commitment on equalization of opportunities for Persons with Disabilities (PWDs).
The National Policy on Disability in Uganda therefore, aims at promoting equal opportunities for enhanced empowerment, participation and protection of rights of PWDs irrespective of gender, age and type of disability.
This is in recognition that PWDs can perform to their full potential given the same conditions and opportunities irrespective of their social, economic and cultural backgrounds.
The Policy is to guide and inform the planning process, resource allocation, implementation, monitoring and evaluation of activities with respect to PWDs concerns at all levels.
Disability in Uganda
Disability is defined as permanent and substantial functional limitation of daily life activities caused by physical, mental or sensory impairment and environmental barriers resulting in limited participations. Over the years definitions of categories have changed from the impairments approach to limitation in participation. This policy will focus on the following disabilities;
Difficulty in hearing, Difficulty in speaking and conveying messages; Difficulty in moving around and using other body parts; Difficulty in seeing; Strange behavior; Epilepsy; Difficulty in learning; Leprosy; Loss of feeling. Multiple disabilities
According to the Uganda Population and Housing Census Report (2002), four out of every 25 persons in Uganda are persons with disabilities.
The report continues to mention that the prevalence rate in 2002 was higher than 11% obtained from the 1991 Census. The prevalence of disability increased with age from 2% among children aged less than 18 years to as high as 18% among the elderly.
The prevalence was not even throughout the country. In the central region, it increased from 1.0% to 3.1%, Eastern region from 1.2% to 3.6%, Western region from 0.9% to 2.9% and Northern region from 1.9% to 4.4%.
The prevalence increase was partly attributed to the improvement in the methods of data collection in the census. This increase may further be attributed to improved service delivery in health care better nutrition, sanitation and community based rehabilitation services which have improved on public awareness, change of attitudes leading those with disabilities living longer.
At 3.4% annual growth rate, the population of PWDs is estimated to have increased to-date.
The most commonly observed disabilities were loss and limited use of limbs 35.3%, spine injuries 22.3%, hearing difficulties 15.1%, seeing difficulties 6.7%, difficulty in speech and conveying messages 3.9%, mental retardation 3.6% mental illness 3.6% and others at 9.6%.
The Northern Region has the highest rate incidence of disability rate at 4.4%.5.
The Vulnerability of PWDs
Generally, PWDs are vulnerable by virtue of their impairment and negative societal attitudes arising from fear, ignorance, superstitions, neglect and lack of awareness.
As a result, PWDs have inadequate access to services, information, resources as well as limited participation in the socio-economic development process. Consequently, the majority depend on their families and communities for survival.
National Minimum Health Care Package (UNMHCP); Community Mobilisation and Empowerment Programmes; Land Reforms, Road Sector Reforms, micro finance initiatives and Modernisation of Agriculture. However, the socio-economic situation of most PWDs is still characterised by abject poverty.
With 46% of their population living in poverty, PWDs are over represented among the 38% of Ugandan population affected by poverty6
Education and skills
Under UPE policy, government provides free education to all children in primary schools. There are 150,559 children with disabilities under this programme, of whom 82,537 are males and 68,022 are females 7 . Approximately 4500 PWDs have been trained in Vocational skills in the Vocational Rehabilitation Institutions since 1967.
The Special Needs Education (SNE), under Ministry of Education and Sports addresses issues of children with learning difficulties. The programmes under Kyambogo University play a key role in training teachers and other professionals in special needs education and rehabilitation.
Furthermore, Government put in place a rehabilitation and resettlement scheme that includes vocational rehabilitation services, sheltered workshops that focus on employable skills training and orthopaedic workshops for provision of assistive devices to PWDs.
Despite the above existing programmes, scarcity of appropriate educational, scholastic and instructional materials, inadequate training staff handling concerns of PWDs, outdated and limited skills in vocational rehabilitation centers, inaccessible physical structures at schools, high costs of assistive devices and assistive services such as guides, helpers as well as interpreters are major factors which hinder PWDs education and skills training.
Therefore, poor access to education in childhood means that a high proportion of PWDs remain illiterate and unskilled. Issues relating to PWDs are not well highlighted in education and training curricula at all levels.
Furthermore, public education programmes often use languages and images that are not comprehensible to most PWDs. Physical accessibility and affordability to programmes are major to education and skills training limitations that constrain participation of PWDs.
With limited skills characteristic of most PWDs, accessing employment is a major challenge. Most potential employers do not give chance to PWDs to compete for employment even where they have the necessary qualifications and experience. Consequently, the majority of PWDs are unemployed.
In an effort to address the employment problem among PWDs, Government established a vocational training programme to equip PWDs with employable skills.
However, these programmes are limited in scope and no longer meet current market employable skills requirements. Government has also started a programme to sensitise employers to recruit qualified and skilled PWDs.
Consequently, some of PWDs have got stable employment. However, absence of a national employment policy has precluded affirmative action for the majority of PWDs who remain unemployed and underemployed.
Most PWDs in Uganda do not have access to regular incomes due to inadequate employment opportunities. Those that earn income are largely in the informal sector.
Existing social security schemes such as pension, provident fund and insurance services cover only PWDs in the formal sector. Where informal social security mechanisms exist, they are weak, unstructured, unsustainable, operate on a voluntary basis and are in any case inaccessible to most PWDs.
The 2002, Uganda Population and Housing Census results revealed that 35.3% of PWDs had loss or limited use of limbs, 23.3% spinal injuries and 15.1% hearing difficulties.
Persons 60 years and above are 1,101,039 of which 18% have chronic diseases associated with old age and disability. Government has put in place the Uganda National Minimum Health Care Package (UNMHC) to ensure that the people of Uganda receive essential services.
In addition, Government has put in place primary health care package, regional referral hospitals, built new and upgraded existing health centres and trained medical staff.
Despite the above scenario, high cost of health services and assistive devices, negative attitudes of some health staff, unfriendly infrastructure and equipment designs, and long distances to the health facilities are still challenges.
The major concerns of PWDs therefore, remain their inability to access basic health services and assistive devices to enable them lead independent and productive lives.
The HIV/AIDS pandemic has destabilised the socio-economic fabric of the country by reducing incomes at household level, increasing the number of orphans and straining health services.
Persons with Disabilities are sexually active. Because of their vulnerability, they stand a higher risk of contracting as well as transmitting HIV/AIDS. Unfortunately, they are not targeted by most programmes on HIV/AIDS.
For instance, PWDs have limited access to information, education, counselling services and ARVs. As a result the impact of HIV/AIDS on PWDs remains unknown.
Government has mobilized resources and put in place the Uganda HIV/AIDS Partnerships to minimise duplication, maximize learning and enhance peer support to fight HIV/AIDS.
It has also put in place programmes focusing on public awareness, community mobilisation and empowerment. Unfortunately, PWDs especially those with hearing and seeing difficulties do not benefit from these interventions.
This is partly because information targeting PWDs often lacks instructional materials, which are printed into large prints or braille, or personnel who know sign language for interpretation. Low levels of literacy among PWDs exacerbates this situation.
Disabilities affect men and women differently, but impact more on females than males due to social and cultural roles. Discriminatory cultural practices on property inheritance and property ownership affect the livelihoods of women with disabilities more adversely than men with disabilities.
This is compounded by inadequate programmes that focus on women with disabilities during service delivery, which makes it even more difficult for them to improve their livelihoods. Government has put in place affirmative action to benefit all PWDs particularly women and girls.
Other steps taken by Government include the land policy, laws on marriage and divorce, inheritance, domestic violence and other forms of violence against women and girls.
In spite of the above, lack of public awareness, negative community attitudes, cultural beliefs and lack of programmes on specific concerns of women with disabilities are still challenges.
In Uganda, PWDs face difficulties in accessing education, health and sports facilities, places of employment, cultural sites and other physical infrastructure.
They are denied access to most buildings such as schools, hospitals, courts of laws, stadias. This is due to the fact that many buildings do not have facilities such as ramps and lifts. The existing lifts do not have talking devices to enable the blind to access information.
Roads do not have facilities for PWDs. In most cases, PWDs cannot access information provided by both electronic and print media. Government has put in place mechanisms to improve and enhance access of services through policies, plans and programmes.
Unfortunately, PWDs continue to experience physical barriers, inadequate information, rehabilitation and unfriendly services. Limited accessibility to such services has contributed to social exclusion of PWDs.
Legal and Planning Framework
Uganda has demonstrated its commitment to the promotion and protection of the rights of PWDs through adoption and implementation of national and international policies and legal (well being ) instruments that concern PWDs.
The Uganda Constitution (1995) recognises the rights of PWDs and provides the basis for the enactment of laws and development of policies that address their concerns.
The Constitution provides for fair representation of marginalized groups on all constitutional and other bodies, recognition of the rights of PWDs to respect and human dignity, and promotion the development of a sign language for the deaf. Furthermore, it enjoins the country to take affirmative action to redress the imbalances that exist against PWDs. Other laws include:-
The Parliamentary Elections Statute of 1996 provides for 5 representatives of PWDs in Parliament, at least one of whom should be a woman and the use of a sign language where applicable;
• The Local Governments Act, of 1997 provides for representation of PWDs (female and male) at all local government levels;
• The Uganda Communications Act of 1997 provides for development of techniques and technologies that facilitate accessibility to communications services by PWDs;
• The Universal Primary Education Act of 1997 commands families with CWDs to give them priority at the time of enrolment;
• The Uganda Traffic and Road Safety Act of 1998 stipulates that PWDs shall not be denied driving permits on the basis of their disability etc. by reason of his or her disability;
• The UNISE Act of 1998 provides for establishment of the Uganda National Institute of Special Education, training of teachers for children with special needs as well as special education teachers;
• The Land Act of 1998 provides that any transaction on customary land that discriminates on PWDs shall be null and void;
• The National Council for Disability Act of 2003 mandates the Council to bring PWDs’ issues to the attention of Government, NGOs, private sector and individuals so as to improve the lives of PWDs.
Participation of PWDs and Caregivers
PWDs do not access services because of their exclusion in the design and implementation of interventions. This has greatly contributed to their inadequate participation in the socio-economic development process.
Government with other stakeholders will promote full participation of PWDs and caregivers in planning, decision-making, designing and implementing interventions for improved service delivery.
Interventions will include:-
i. Facilitate the availability and utilisation of assistive devices and services to PWDs to make them independent and productive in development activities;
ii. Promoting representation of PWDs and caregivers in planning, monitoring and evaluation at all levels;
iii. Supporting the development and strengthening of Disabled Persons Organisations DPOs) for a stronger voice;
iv. Creating enabling environment for effective and equal participation of PWDs.
Most PWDs lack knowledge and skills to effectively participate in and benefit from development. Similarly, caregivers and service providers have low capacity to render adequate services. To this end, the policy will ensure that capacity building for all stakeholders is prioritized in all interventions at all levels.
Interventions will include:-
i. Promoting apprenticeships, vocational, functional and lifelong skills training;
ii. Establishing community based networks to access PWDs to services;
iii. Equipping service providers and communities with appropriate knowledge and skills for effective service delivery;
iv. Promoting micro-finance education and health initiatives that benefit households of PWDs and their caregivers;
Communities often discriminate against and marginalize PWDs because of negative beliefs, norms and customs. This is mainly due to the limited understanding by the communities of the causes of disabilities as well as of the rights, potentials and abilities of PWDs.
Interventions will include:-
i. Promoting and strengthening awareness creation programmes on disability at all levels;
ii. Designing and developing appropriate interventions by stakeholders at all levels;
iii. Promoting theatre in development;
iv. Lobbying for the mainstreaming of disability concerns in sectoral programmes;
v. Publicity through the media such as radio, T.V, Newspapers, brochures and posters.
Congenital and non-congenital factors are responsible for the impairment of PWDs in Uganda .Some of these factors can be controlled and managed, if they are identified early enough.
This policy will support efforts towards strengthening early identification, prevention and management of disabilities. Government will therefore encourage service providers and communities to participate in early detection, assessment, management, referral for treatment and rehabilitation.
Care and Support
Care and support will include provision of basic, physical and psychosocial needs of PWDs and their caregivers. Psychosocial issues transcend one sector and should be addressed by all sectors.
The information above is an extract from Uganda National policy on Disability.