World Health Organization

World Health Organization
Informe Mundial sobre Discapacidad ROMPER BARRERAS PARA INCLUIR

Antecedentes World Health Organization Asamblea Mundial de Salud Resolución (Mayo 2005) sobre “Discapacidad, incluida la prevención, el tratamiento y la rehabilitación” que pide a la OMS de realizar un Informe Mundial Desarrollado y publicado en sociedad con el Banco Mundial Convencion sobre los Derechos de las Personas con Discapacidad Tratado de la ONU que entró en vigencia en mayo del 2008 How did the World Report on Disability come about? Like everything that WHO does, it began with a resolution from the World Health Assembly, the governing body of the Organization. Subsequently, the World Report on Disability was developed jointly with the World Bank, as disability is broader than health, rehabilitation and community living. The wider context was the CRPD, the major international treaty which reinforces our understanding of disability as a human rights and as a development issue. This treaty has now been signed by XX countries and ratified by ZZ countries [As of July 15, 149 signatories and 103 ratifications but check latest figures at The CRPD understands disability to arise from the relationship between a person with an impairment and the wider environment. This interactional approach is consistent with the WHO ICF classification, which emphasises the role of the environment in either enabling or disabling people with health conditions. The CRPD has been described as the "moral compass of the report", while the ICF provides the conceptual framework.

Antecedentes Refuerza nuestra comprensión de la discapacidad como un asunto de derechos humanos y desarrollo Clasificación Internacional del Funcionamiento, la Discapacidad y la Salud (CIF) Pone énfasis en el rol del ambiente habilitando o discapacitando a las personas con condiciones de salud Adoptada como el modelo conceptual del informe

Objetivos del Informe Mundial sobre la Discapacidad
World Health Organization Proporcionar a los Gobiernos y la sociedad civil una descripción completa de la importancia de la discapacidad y un análisis de las respuestas suministradas, sobre la base de la mejor evidencia científica disponible; Recomendar acciones a nivel nacional e internacional para mejorar la vida de las personas con discapacidad Apoyar la ejecución de la Convención sobre los Derechos de las Personas con Discapacidad The World Report on Disability fills a major gap, by providing evidence on the global disability situation. It answers questions such as "how many disabled people are there?" "What is the extent of need and unmet need?" "What are the barriers to participation?" and "What works to overcome those barriers". The World Report also helps by showing what works, and highlighting what can be done, in line with the CRPD, to improve the lives of persons with disabilities, for example better policy, more accessible services, better knowledge, and training for professionals from health and other fields so they understand the human rights approach to disability. The World Report therefore provides evidence which underpins many Articles of the CRPD, and will assist member states in the implementation of the CRPD.

Cómo se realizó el Informe Mundial?
World Health Organization Participación de numerosas partes interesadas: comité asesor y editorial; más de 380 colaboradores; más de 70 paises de bajos, medios y altos ingresos representados We know that disability is complex and multi-dimensional. If we are to address disability disadvantage, we need to work together. That is why it was so important to involve a wide range of people in developing the report. Over 380 people from 70 different countries contributed to the report, including academics, policy-makers, professionals, disability rights advocates and people from the NGO community. The report has been through an extensive consultation process in all WHO regions and rigorous peer review. A particular feature is the involvement of people with disabilities themselves. People with disabilities have been on the advisory committee, the editorial committee as contributors and peer reviewers. Personal testimonies from people with disability open each chapter, some of which can be found at greater length on the website for the report.

Cómo se realizó el Informe Mundial?
World Health Organization Largo proceso de revisión: Consultas regionales, examen por homólogos. Las personas con discapacidad ocuparon un puesto central en el proceso We know that disability is complex and multi-dimensional. If we are to address disability disadvantage, we need to work together. That is why it was so important to involve a wide range of people in developing the report. Over 380 people from 70 different countries contributed to the report, including academics, policy-makers, professionals, disability rights advocates and people from the NGO community. The report has been through an extensive consultation process in all WHO regions and rigorous peer review. A particular feature is the involvement of people with disabilities themselves. People with disabilities have been on the advisory committee, the editorial committee as contributors and peer reviewers. Personal testimonies from people with disability open each chapter, some of which can be found at greater length on the website for the report.

Cual es la informacion que nos da el Informe?
World Health Organization Estimaciones de prevalencia más elevadas 1000 millones de personas (15%), de las cuales milliones son adultos con considerables dificultades de funcionamiento Número creciente de afectados En parte por el envejecimiento de la población, el aumento de condiciones de salud crónicas, accidentes de tránsito, desastres naturales etc. So, turning to the evidence in the World Report. First, it tells us something about people with disabilities as a group. Since the 1970s, WHO has been saying that 10% of the population are disabled. Now, through analysis of the World Health Survey (WHS), the Global Burden of Disease (GBD) Survey, and national surveys, we can see that a more accurate estimate is 15% or one billion people. Secondly, the World Report tells us about trends: there are increasing numbers of PWD, because we are living longer (and older people have a higher risk of disability) and because chronic diseases such as arthritis, diabetes and heart diseases are on the rise. Finally, disability is very diverse and affects people unequally. Poor people , women and older people are more likely to experience disability. And while disability correlates with disadvantage not all people with disabilities are equally disadvantaged. School enrolments differ among impairments. Those most excluded form the labour market are people with intellectual impairments and people with mental health conditions.

Cual es la informacion que nos da el Informe?
World Health Organization Afecta de manera desproporcionada a las poblaciones vulnerables: mujeres, adultos mayores y personas pobres. No todas las personas con discapacidad tienes las mismas desventajas. So, turning to the evidence in the World Report. First, it tells us something about people with disabilities as a group. Since the 1970s, WHO has been saying that 10% of the population are disabled. Now, through analysis of the World Health Survey (WHS), the Global Burden of Disease (GBD) Survey, and national surveys, we can see that a more accurate estimate is 15% or one billion people. Secondly, the World Report tells us about trends: there are increasing numbers of PWD, because we are living longer (and older people have a higher risk of disability) and because chronic diseases such as arthritis, diabetes and heart diseases are on the rise. Finally, disability is very diverse and affects people unequally. Poor people , women and older people are more likely to experience disability. And while disability correlates with disadvantage not all people with disabilities are equally disadvantaged. School enrolments differ among impairments. Those most excluded form the labour market are people with intellectual impairments and people with mental health conditions.

Barreras discapacitantes: pruebas de su existencia
World Health Organization Barreras discapacitantes: pruebas de su existencia Políticas y normas inadecuadas Actitudes negativas Falta de prestación de servicios Problemas con la prestación de servicios As we mentioned, both the CRPD and the ICF highlight the role that the environment can play in facilitating or restricting participation. The World Report provides strong evidence of some of the most common barriers faced by people with disabilities. The environment can be modified. As such much of the disadvantage experienced by people with disabilities is preventable. We can do something about these problems! To the right of the slide, you can see three of the women in WHO You Tube videos. From Lebanon, Mia told us about the discrimination she had faced in education. From United Republic of Tanzania, Faustina explained how assistive devices such as wheelchairs are vital to empowerment. In United Kingdom, Rachael told us about the obstacles she had had to overcome in order to train and work as a nurse.

Barreras discapacitantes: pruebas de su existencia
World Health Organization Barreras discapacitantes: pruebas de su existencia Financiamiento insuficiente Falta de accesibilidad Falta de consultas y participación Falta de datos y pruebas As we mentioned, both the CRPD and the ICF highlight the role that the environment can play in facilitating or restricting participation. The World Report provides strong evidence of some of the most common barriers faced by people with disabilities. The environment can be modified. As such much of the disadvantage experienced by people with disabilities is preventable. We can do something about these problems! To the right of the slide, you can see three of the women in WHO You Tube videos. From Lebanon, Mia told us about the discrimination she had faced in education. From United Republic of Tanzania, Faustina explained how assistive devices such as wheelchairs are vital to empowerment. In United Kingdom, Rachael told us about the obstacles she had had to overcome in order to train and work as a nurse.

Consecuencias de las barreras discapacitantes
World Health Organization Consecuencias de las barreras discapacitantes Peor estado de salud que en la población en general Menores logros académicos Menor actividad económica What are the outcomes of these barriers? Poorer health than the general population. Lower educational achievements: Children with disabilities are less likely to start school than their non disabled peers and more likely to drop out. Even in countries where most non disabled children go to school – disabled with disabilities do not go to school. For example: - in Bolivia about 98% of non disabled children go to school, but less than 40% of disabled children go to school; - In Indonesia over 80% of non disabled children go to school, but less than 25% of children with disabilities go to school. Less economic participation: disabled people are less likely to be employed, and generally earn less when employed. A recent OECD study found that the inactivity rate for people with disability (49%) was 2.5 times higher than among persons without disability (20%). As a result, people with disabilities have higher rates of poverty - including food insecurity, poor housing, lack of access to safe water and inadequate access to health care as well as fewer assets. People with disabilities often face extra costs for example for healthcare and assistance. PWD also experience increased dependency and restricted participation: for example as a result of institutionalisation, lack of access to transport and environments, and this results in isolation. The important thing is to realise that it is not so much the health condition which causes problems for people with disabilities – it is the way that society treats people with a health condition which matters most.

Consecuencias de las barreras discapacitantes
World Health Organization Consecuencias de las barreras discapacitantes Tasas de pobreza más altas Menor independencia y participación reducida Lo que importa más es la manera en que la sociedad trata a las personas con discapacidad What are the outcomes of these barriers? Poorer health than the general population. Lower educational achievements: Children with disabilities are less likely to start school than their non disabled peers and more likely to drop out. Even in countries where most non disabled children go to school – disabled with disabilities do not go to school. For example: - in Bolivia about 98% of non disabled children go to school, but less than 40% of disabled children go to school; - In Indonesia over 80% of non disabled children go to school, but less than 25% of children with disabilities go to school. Less economic participation: disabled people are less likely to be employed, and generally earn less when employed. A recent OECD study found that the inactivity rate for people with disability (49%) was 2.5 times higher than among persons without disability (20%). As a result, people with disabilities have higher rates of poverty - including food insecurity, poor housing, lack of access to safe water and inadequate access to health care as well as fewer assets. People with disabilities often face extra costs for example for healthcare and assistance. PWD also experience increased dependency and restricted participation: for example as a result of institutionalisation, lack of access to transport and environments, and this results in isolation. The important thing is to realise that it is not so much the health condition which causes problems for people with disabilities – it is the way that society treats people with a health condition which matters most.

Indice de contenido World Health Organization Comprender la discapacidad La situación mundial en materia de discapacidad Atención de la salud en general Rehabilitación Asistencia y apoyo This slide shows the cover of the World Report which is one of the pictures taken from a poster series breaking barriers. There are nine chapters that include disability concepts, data, general healthcare, rehabilitation, assistance and support, environments (buildings, transport and information and communication) as well as education and employment. The World report does not cover the whole of the CRPD, but it does cover key areas necessary for inclusion in society. Each chapter has a similar structure, looking at need and unmet need, then barriers, and then ways of overcoming barriers. There are specific recommendations at the end of each chapter, as well as the general recommendations at the end of the report.

Indice de contenido World Health Organization Ambientes favorables Educación Trabajo y empleo De cara al futuro: recomendaciones This slide shows the cover of the World Report which is one of the pictures taken from a poster series breaking barriers. There are nine chapters that include disability concepts, data, general healthcare, rehabilitation, assistance and support, environments (buildings, transport and information and communication) as well as education and employment. The World report does not cover the whole of the CRPD, but it does cover key areas necessary for inclusion in society. Each chapter has a similar structure, looking at need and unmet need, then barriers, and then ways of overcoming barriers. There are specific recommendations at the end of each chapter, as well as the general recommendations at the end of the report.

Datos: problemas, dificultades y soluciones
World Health Organization Datos: problemas, dificultades y soluciones La discapacidad es compleja y mesurarla puede ser difícil. Falta de coherencia en las definiciones y metodología en los diferentes países. Hay que utilizar instrumentos que reflejen la complexidad de la discapacidad, por ejemplo que reconozcan la discapacidad como un espectro, la función del ambiente, y que midan las dificultades de funcionamiento en vez que el numero de personas discapacitadas. Disability is complex and can be difficult to measure. Different approaches and definitions have been adopted around the world, which do not always cover all aspects of disability and make comparison difficult. There is enormous scope for enhancing the availability and quality of data on disability. Disability is on a spectrum, and the environment always plays an important role. Disability can also be a temporary state. These characteristics of disability need to be reflected in data collection tools so that a more true representation of disability is achieved. Impairment data is not a proxy for disability data. Data gathered needs to be relevant at the national level and comparable at the global level – both of which can be achieved by basing design on international standards, like the International Classification of Functioning, Disability and Health (ICF). Using the ICF allows for consistency in how disability is measured and ensures that results from different studies can be compared. Using the ICF means that data is collected on ALL the components of disability: impairments, activity limitations and participation restrictions, related health conditions, and environmental factors. Improving national statistics can be achieved, particularly by moving away from measuring only impairment towards taking a ‘difficulties in functioning’ approach. It is useful if the country’s Census incorporates the UN Washington Group’s questions, and if disability questions are added into existing sample surveys. Where resources exist to carry out comprehensive disability surveys this can greatly add to the detail and level of understanding of the situation of people with disabilities, and to the information about subgroups, such as children, women and older people. Improving the comparability of data will be promoted by these national improvements, by refining the methods we use to generate prevalence estimates, and by collaborating on comparable definitions and methods for data collection. Further work is needed to gain a better understanding of environments and their influences, of the relationships between health conditions and disability, and to understand the lived experience of people with disabilities. Better information will support better policy making, will enable us to monitor progress in terms of the CRPD and will, hopefully, lead to improvements in the lives of people with disability.

Datos: problemas, dificultades y soluciones
World Health Organization Datos: problemas, dificultades y soluciones Adoptar la CIF Mejorar las estadísticas nacionales Mejorar la comparabilidad de los datos Elaborar instrumentos apropiados y cubrir los déficits de investigación Disability is complex and can be difficult to measure. Different approaches and definitions have been adopted around the world, which do not always cover all aspects of disability and make comparison difficult. There is enormous scope for enhancing the availability and quality of data on disability. Disability is on a spectrum, and the environment always plays an important role. Disability can also be a temporary state. These characteristics of disability need to be reflected in data collection tools so that a more true representation of disability is achieved. Impairment data is not a proxy for disability data. Data gathered needs to be relevant at the national level and comparable at the global level – both of which can be achieved by basing design on international standards, like the International Classification of Functioning, Disability and Health (ICF). Using the ICF allows for consistency in how disability is measured and ensures that results from different studies can be compared. Using the ICF means that data is collected on ALL the components of disability: impairments, activity limitations and participation restrictions, related health conditions, and environmental factors. Improving national statistics can be achieved, particularly by moving away from measuring only impairment towards taking a ‘difficulties in functioning’ approach. It is useful if the country’s Census incorporates the UN Washington Group’s questions, and if disability questions are added into existing sample surveys. Where resources exist to carry out comprehensive disability surveys this can greatly add to the detail and level of understanding of the situation of people with disabilities, and to the information about subgroups, such as children, women and older people. Improving the comparability of data will be promoted by these national improvements, by refining the methods we use to generate prevalence estimates, and by collaborating on comparable definitions and methods for data collection. Further work is needed to gain a better understanding of environments and their influences, of the relationships between health conditions and disability, and to understand the lived experience of people with disabilities. Better information will support better policy making, will enable us to monitor progress in terms of the CRPD and will, hopefully, lead to improvements in the lives of people with disability.

Atención de la salud en general
Las personas con discapacidad tienen necesidades de salud ordinarias. Además, algunas personas con discapacidad pueden tener un riesgo mayor de desarrollar condiciones secundarias o concurrentes, adoptar conductas de riesgo, ser victimas de violencias o sufrir lesiones no intencionales.

Atención de la salud en general
Este capitulo se focaliza en las barreras que las personas con discapacidad enfrentan cuando intentan acceder a los servicios de salud.

Atención de la salud: problemas y desafíos
World Health Organization Atención de la salud: problemas y desafíos Riesgo de ignorar las necesidades de atención de la salud en general: «ensombrecimiento diagnóstico». Margen de salud más estrecho: por ej. condiciones secundarias y concurrentes. Posibles comportamientos de riesgo: por ej. humo, mala alimentación, inactividad física. Mayor riesgo de exposición a la violencia, a menudo también un mayor riesgo de sufrir lesiones no intencionales People with disabilities have ordinary health needs. Some people with disabilities may also be particularly vulnerable to secondary conditions – such as pressure sores or bladder infections for people with spinal cord injury or MS – or to co-morbidities such as diabetes for people with schizophrenia. They may also engage in risky behaviours and be vulnerable to violence and unintentional injuries. The emphasis of the health chapter is on barriers which people with disabilities experience in accessing mainstream healthcare. People with disabilities experience barriers in accessing healthcare. For example, World Health Survey analysis revealed that people with disabilities were: more than twice as likely to find healthcare provider skills or equipment inadequate to meet their needs, nearly three times more likely to be denied care and four times more likely to be treated badly Cost, distance and transport are the main barriers to accessing healthcare. In low-income countries more than half of people with disabilities are unable to afford healthcare, compared with one third of nondisabled people. People with disabilities spend more of their total household expenditure on out of pocket heath-care costs (15%) than non disabled people (11%). As a result they are more vulnerable to catastrophic health expenditure. From the WHS, nearly 30% of PWDs spend more than 40% of their income on health, compared to 20% for non disabled people. Low income countries showed even higher rates. Health insurance should be an option BUT people with disabilities across the world experience difficulties when accessing government or private healthcare systems, for example, social insurance- commonly linked to payroll contributions - are also often in accessible because PWD have lower employment rates.

Atención de la salud: problemas y deafios
World Health Organization Barreras que obstan a la atención de la salud: 2 x probabilidad preparación insuficiente del prestador de servicios o equipos inadecuados; 3 x probabilidad que se le denegue la atención 4x probabilidad de ser maltratado/a. Informaciones o instalaciones inaccesibles, falta de transporte. Las barreras de costo son fundamentales: 50% o mas de riesgo de incurrir en gastos catastróficos en salud. People with disabilities have ordinary health needs. Some people with disabilities may also be particularly vulnerable to secondary conditions – such as pressure sores or bladder infections for people with spinal cord injury or MS – or to co-morbidities such as diabetes for people with schizophrenia. They may also engage in risky behaviours and be vulnerable to violence and unintentional injuries. The emphasis of the health chapter is on barriers which people with disabilities experience in accessing mainstream healthcare. People with disabilities experience barriers in accessing healthcare. For example, World Health Survey analysis revealed that people with disabilities were: more than twice as likely to find healthcare provider skills or equipment inadequate to meet their needs, nearly three times more likely to be denied care and four times more likely to be treated badly Cost, distance and transport are the main barriers to accessing healthcare. In low-income countries more than half of people with disabilities are unable to afford healthcare, compared with one third of nondisabled people. People with disabilities spend more of their total household expenditure on out of pocket heath-care costs (15%) than non disabled people (11%). As a result they are more vulnerable to catastrophic health expenditure. From the WHS, nearly 30% of PWDs spend more than 40% of their income on health, compared to 20% for non disabled people. Low income countries showed even higher rates. Health insurance should be an option BUT people with disabilities across the world experience difficulties when accessing government or private healthcare systems, for example, social insurance- commonly linked to payroll contributions - are also often in accessible because PWD have lower employment rates.

Atención de la salud: soluciones
World Health Organization Reformar las políticas y la legislación. Financiamiento: seguros médicos, fondos dirigidos hacia los sistemas de sanidad , complemento de los ingresos, reducción de tarifas, incentivos a los prestadores de servicios, transferencias monetarias condicionadas. Prestación de servicios: ajustes razonables, incluso información en formatos accesible, intervenciones específicas, coordinación. To overcome barriers, it is necessary to: - reform policy and legislation - establish standards for healthcare (in high income countries, disability access and quality standards can be built into contracts with providers). - address affordability problems (through health insurance, targeted funding, income support or reducing out of pocket expenditure); - improve physical access to premises, transport and equipment; - train healthcare workers particularly around a human rights-based approach to disability, and challenge negative attitudes. People with disabilities and their representative organizations can be providers of training. In LMIC, CBR can play a role in promoting access to healthcare. In all settings, empowering PWD to look after their own health through information, training and peer support is a good strategy. To fill the gaps in data and research, PWD need to be included in research and disaggregated data on service use is required.

Atención de la salud: soluciones
World Health Organization . Recursos Humanos: educación y formación. RBC: para promover el acceso a los servicios de salud. Investigación: incluir a las personas con discapacidad y desglosar los datos To overcome barriers, it is necessary to: - reform policy and legislation - establish standards for healthcare (in high income countries, disability access and quality standards can be built into contracts with providers). - address affordability problems (through health insurance, targeted funding, income support or reducing out of pocket expenditure); - improve physical access to premises, transport and equipment; - train healthcare workers particularly around a human rights-based approach to disability, and challenge negative attitudes. People with disabilities and their representative organizations can be providers of training. In LMIC, CBR can play a role in promoting access to healthcare. In all settings, empowering PWD to look after their own health through information, training and peer support is a good strategy. To fill the gaps in data and research, PWD need to be included in research and disaggregated data on service use is required.

Rehabilitación La rehabilitación ayuda a las personas que padecen alguna discapacidad a lograr y mantener un funcionamiento óptimo en interacción con su entorno, reduciendo el efecto de las varias condiciones de salud.

Rehabilitación: problemas y desafíos
World Health Organization La rehabilitación es una inversión productiva ya que permite desarrollar el capital humano y promueve la participación. Los datos globales sobre las necesidades satisfechas y no satisfechas son escasos, pero las encuestas nacionales revelan grandes deficiencias en el suministro de dispositivos asistenciales y actividades de rehabilitación médica Rehabilitation assists individuals with disability to achieve and maintain optimal functioning in interaction with their environment by reducing the impact of a broad range of health conditions. Yet rehabilitation is a neglected area of healthcare, and of disability policy generally. (supporting information for Bullet 2) For example, a 2005 global survey of the implementation of the nonbinding, UN Standard Rules on the Equalization of Opportunities for Persons with Disabilities in 114 countries found that: - 42% countries had not adopted rehabilitation policies. - 50% did not pass legislation on rehabilitation. - 40% did not establish rehabilitation programmes. Evidence from studies conducted in Malawi, Mozambique, Namibia, Zambia, and Zimbabwe reveal large gaps in the provision of medical rehabilitation: % of people who needed the services did not receive them; and % of people who needed assistive devices did not receive them. Inequalities between men and women, between rural and urban dwellers and based on socioeconomic status were also found. Just in the area of hearing aid provision, hearing aid producers and distributors estimate that hearing aid production currently meets less than 10% of global need, and less than 3% of the hearing aid needs in developing countries are met annually. A recent global survey (2006‑2008) of vision services in 195 countries found that waiting times in urban areas averaged less than one month, while waiting times in rural areas ranged from six months to a year. (….Bullet 4) There are insufficient rehabilitation personnel with appropriate capacity. For example the 30 million people who need prostheses, orthotics and related services in Africa, Asia, and Latin America require an estimated rehabilitation professionals. However, in 2005 there were only 24 prosthetic and orthotic schools in developing countries, graduating just 400 trainees annually. (….Bullet 5) Services also tend to be centralized (that is, concentrated in urban areas) leaving the rural poor with little or no access to rehabilitation. Referral systems are generally inadequate with services operating in a fragmented and poorly coordinated manner. (….Bullet 6) At the policy and legislation level, there is a lack of responsibility taken by Governments, inadequate strategic planning, and implementation. There is limited government spending and selective coverage.

Rehabilitación: problemas y desafíos
World Health Organization El acceso limitado resulta en el deterioro de las condiciones de salud, limitaciones en las actividades y el la participación, menor independencia y baja calidad de vida Escasez de personal especializado en rehabilitación: capacidad limitada, sobretodo en África. Problemas sistémicos: centralización de los servicios de rehabilitación, falta de servicios de derivación eficaces Necesidad de invertir más en los servicios de rehabilitación Rehabilitation assists individuals with disability to achieve and maintain optimal functioning in interaction with their environment by reducing the impact of a broad range of health conditions. Yet rehabilitation is a neglected area of healthcare, and of disability policy generally. (supporting information for Bullet 2) For example, a 2005 global survey of the implementation of the nonbinding, UN Standard Rules on the Equalization of Opportunities for Persons with Disabilities in 114 countries found that: - 42% countries had not adopted rehabilitation policies. - 50% did not pass legislation on rehabilitation. - 40% did not establish rehabilitation programmes. Evidence from studies conducted in Malawi, Mozambique, Namibia, Zambia, and Zimbabwe reveal large gaps in the provision of medical rehabilitation: % of people who needed the services did not receive them; and % of people who needed assistive devices did not receive them. Inequalities between men and women, between rural and urban dwellers and based on socioeconomic status were also found. Just in the area of hearing aid provision, hearing aid producers and distributors estimate that hearing aid production currently meets less than 10% of global need, and less than 3% of the hearing aid needs in developing countries are met annually. A recent global survey (2006‑2008) of vision services in 195 countries found that waiting times in urban areas averaged less than one month, while waiting times in rural areas ranged from six months to a year. (….Bullet 4) There are insufficient rehabilitation personnel with appropriate capacity. For example the 30 million people who need prostheses, orthotics and related services in Africa, Asia, and Latin America require an estimated rehabilitation professionals. However, in 2005 there were only 24 prosthetic and orthotic schools in developing countries, graduating just 400 trainees annually. (….Bullet 5) Services also tend to be centralized (that is, concentrated in urban areas) leaving the rural poor with little or no access to rehabilitation. Referral systems are generally inadequate with services operating in a fragmented and poorly coordinated manner. (….Bullet 6) At the policy and legislation level, there is a lack of responsibility taken by Governments, inadequate strategic planning, and implementation. There is limited government spending and selective coverage.

Rehabilitación: soluciones
World Health Organization Políticas, leyes y sistemas normativos Financiamiento: hacer frente a los gastos y a la cobertura a través de cooperación internacional, alianzas, fondos dirigidos a los servicios de rehabilitación. Recursos humanos: Ampliación de la capacitación y de la disponibilidad de personal de rehabilitación a través de programas de educación y formación y de mecanismos para contratar y retener el personal. Trabajadores de nivel medio como primera etapa Policy responses should emphasize early intervention, the benefits of rehabilitation to promote functioning in people with a broad range of health conditions, and the provision of services as close as possible to where people live. Creating or implementing national plans on rehabilitation, and establishing infrastructure and capacity to implement the plan are critical to improving access to rehabilitation. Funding mechanisms to address barriers related to financing of rehabilitation require careful evaluation for their applicability and cost-effectiveness. Mechanisms may include: reallocation or redistribution of resources; support through international cooperation; public-private partnerships for service provision; making essential rehabilitation services available free of charge for poor people with disabilities who cannot afford to pay; and promoting equitable access to rehabilitation through health insurance. Increasing human resources for rehabilitation and productivity will require training capacity to be built in accord with national rehabilitation plans; the identification of incentives and mechanisms for retaining personnel especially in rural and remote areas; and the training of non-specialist health professionals (doctors, nurses, primary care workers, CBR workers) on disability and rehabilitation relevant to their roles and responsibilities. Established rehabilitation services should focus on improving efficiency and effectiveness, by expanding coverage and improving quality and affordability. Client centred and multidisciplinary approaches should be encouraged. In less-resourced settings the focus should be on accelerating the supply of services through community-based rehabilitation (CBR), complemented by referrals to secondary services. In all cases service users must be included in decision making – rehab is always voluntary. Increase the use and affordability of technology and assistive devices. Access to assistive technologies can be improved by pursuing economies of scale, manufacturing and assembling products locally, and reducing import taxes. Expanding research programmes, including improving information and access to good-practice guidelines is essential.

Rehabilitación: soluciones
World Health Organization Provisión de servicios: integración en el sistema de salud, coordinación, servicios basados en la comunidad, intervención temprana. Dispositivos asistenciales: adecuados a las necesidades del usuario, seguimiento adecuado, producción local, reducción de los impuestos. Investigación y práctica clínica basadas en la evidencia Policy responses should emphasize early intervention, the benefits of rehabilitation to promote functioning in people with a broad range of health conditions, and the provision of services as close as possible to where people live. Creating or implementing national plans on rehabilitation, and establishing infrastructure and capacity to implement the plan are critical to improving access to rehabilitation. Funding mechanisms to address barriers related to financing of rehabilitation require careful evaluation for their applicability and cost-effectiveness. Mechanisms may include: reallocation or redistribution of resources; support through international cooperation; public-private partnerships for service provision; making essential rehabilitation services available free of charge for poor people with disabilities who cannot afford to pay; and promoting equitable access to rehabilitation through health insurance. Increasing human resources for rehabilitation and productivity will require training capacity to be built in accord with national rehabilitation plans; the identification of incentives and mechanisms for retaining personnel especially in rural and remote areas; and the training of non-specialist health professionals (doctors, nurses, primary care workers, CBR workers) on disability and rehabilitation relevant to their roles and responsibilities. Established rehabilitation services should focus on improving efficiency and effectiveness, by expanding coverage and improving quality and affordability. Client centred and multidisciplinary approaches should be encouraged. In less-resourced settings the focus should be on accelerating the supply of services through community-based rehabilitation (CBR), complemented by referrals to secondary services. In all cases service users must be included in decision making – rehab is always voluntary. Increase the use and affordability of technology and assistive devices. Access to assistive technologies can be improved by pursuing economies of scale, manufacturing and assembling products locally, and reducing import taxes. Expanding research programmes, including improving information and access to good-practice guidelines is essential.

Asistencia y apoyo Asistencia y apoyo se refieren a formas no terapeutica de ayuda que permiten a las personas de conducir una vida independiente y participar en las actividades sociales.

Asistencia y apoyo: problemas y desafios
World Health Organization El acceso a prestaciones de asistencia y de apoyo es un prerrequisito para la participación. Se prefieren generalmente las soluciones institucionales. La provisión de servicios formales es limitada en los países a bajos y medios ingresos. Assistance and Support refers to non-therapeutic forms of help which enable people to live independently and participate in society. For example, personal assistants, sign language interpreters and other forms of assistance and support can help people with disabilities to go to school, to get jobs, and to live in the community. Where provision does exist, historically it has been in residential institutions. These segregate people with disabilities from society, restrict choices, and increase vulnerability to abuse. Where community services exist, they may not be responsive to the needs of people with disabilities or their families. Private services may be unavailable or unaffordable. NGO's may be the only service providers but may not be regulated to ensure quality of provision. There is extensive evidence of unmet need, even in high income countries 20%-40% do not have needs met. There is also a problem with supply and quality of support staff in many countries. Other barriers include lack of coordination, negative attitudes, and vulnerability of service users. Without effective assistance and support, not only are people with disabilities isolated and excluded, their families and friends also have to provide informal support, thus excluding them also from labour market or schooling.

Asistencia y apoyo: problemas y desafios
World Health Organization Incluso en los países de altos ingresos, entre 20 y 40 % de las personas no tienes cubiertas sus necesidades La falta de servicios de apoyo provoca aislamiento social, dependencia de los demás, imposibilidad de elección y control, riesgo de abuso. La falta de servicios de apoyo puede también tener consecuencias negativas sobre los cuidadores informales Assistance and Support refers to non-therapeutic forms of help which enable people to live independently and participate in society. For example, personal assistants, sign language interpreters and other forms of assistance and support can help people with disabilities to go to school, to get jobs, and to live in the community. Where provision does exist, historically it has been in residential institutions. These segregate people with disabilities from society, restrict choices, and increase vulnerability to abuse. Where community services exist, they may not be responsive to the needs of people with disabilities or their families. Private services may be unavailable or unaffordable. NGO's may be the only service providers but may not be regulated to ensure quality of provision. There is extensive evidence of unmet need, even in high income countries 20%-40% do not have needs met. There is also a problem with supply and quality of support staff in many countries. Other barriers include lack of coordination, negative attitudes, and vulnerability of service users. Without effective assistance and support, not only are people with disabilities isolated and excluded, their families and friends also have to provide informal support, thus excluding them also from labour market or schooling.

Asistencia y apoyo: soluciones
World Health Organization Desinstitucionalización: plan de transición, asignar recursos suficientes, asegurar la presencia de recursos humanos adecuados. Mejorar políticas y practicas: crear marcos normativos y procesos de evaluación, mejorar los mecanismos de coordinación y las normas de control Mejorar la asequibilidad: redistribución de recursos, creación de incentivos fiscales, contrataciones, transferencias de fundos. How can we solve these problems? Particularly in high and middle income countries, the report recommends approaches such as transition away from institutions, commissioning of services in the community, independent living units so that people with disabilities have maximum choice and independence, and provision of information and respite care to support families. Governments should develop mechanisms for assessing need, contracting out care, and ensuring high quality. More investment in support services is needed, particularly in middle income countries. Reallocation of funding from institutions to community living can help meet financial needs. A range of solutions are needed as disabled people are different and their needs and desires vary. A "mixed economy of care" should be looked at, that is, provision of services by not-for-profit, for-profit as well as by the state. Training schemes are needed to ensure supply of support staff, sign language interpreters, advocates etc. In low income settings, Community Based Rehabilitation (CBR) can help empower people with disabilities and their families. In all settings, it is important to prevent and monitor abuse, to which people with disabilities are particularly vulnerable. Wherever possible, people with disabilities should be in control, with professionals "on tap but not on top". Even when paid support is unrealistic, changing relationships between those who provide and those who receive support, to ensure choice and control, is possible and desirable. DPOs have a role to support people with disabilities to become independent, and investment in DPOs is important.

Asistencia y apoyo: soluciones
World Health Organization Extender los servicios comunitarios: desarrollar una economía mixta de servicios de atención, en particular para apoyar a los mecanismos para una vida independiente; desarrollar sistemas de relevo y otros tipos de apoyo para las familias; crear planes de capacitación para interpretes de lengua de señas. Fortalecer las capacidades de los proveedores de servicios y de los usuarios, aumentar la inclusión y la capacidad de control de los consumidores. How can we solve these problems? Particularly in high and middle income countries, the report recommends approaches such as transition away from institutions, commissioning of services in the community, independent living units so that people with disabilities have maximum choice and independence, and provision of information and respite care to support families. Governments should develop mechanisms for assessing need, contracting out care, and ensuring high quality. More investment in support services is needed, particularly in middle income countries. Reallocation of funding from institutions to community living can help meet financial needs. A range of solutions are needed as disabled people are different and their needs and desires vary. A "mixed economy of care" should be looked at, that is, provision of services by not-for-profit, for-profit as well as by the state. Training schemes are needed to ensure supply of support staff, sign language interpreters, advocates etc. In low income settings, Community Based Rehabilitation (CBR) can help empower people with disabilities and their families. In all settings, it is important to prevent and monitor abuse, to which people with disabilities are particularly vulnerable. Wherever possible, people with disabilities should be in control, with professionals "on tap but not on top". Even when paid support is unrealistic, changing relationships between those who provide and those who receive support, to ensure choice and control, is possible and desirable. DPOs have a role to support people with disabilities to become independent, and investment in DPOs is important.

Ambientes favorables Los ambientes físicos, sociales y actitudinales pueden generar discapacidad o facilitar la inclusión.

Ambientes favorables El término accesibilidad describe el grado en que un entorno, un servicio o un producto permiten el acceso de tantas personas como sea posible, en particular de personas con discapacidad.

Ambientes favorables problemas y desafíos
World Health Organization Los ambientes (físicos, sociales y actitudinales) pueden generar discapacidad o facilitar la inclusión El acceso a lugares públicos es esencial para la educación, la atención médica y la participación en el mercado laboral Sin embargo, bajo nivel de cumplimiento con las reglas de accesibilidad, necesidad de normas adecuadas y de mecanismos de cumplimiento Environments (physical, social, attitudinal) can be enabling or disabling Unless people with disabilities can access buildings, transport and information, they cannot access healthcare or participate in schools, work or society. The key barriers which are reported include: Low level of compliance with laws on accessibility. Reports from countries with laws on accessibility, even those dating from 20 to 40 years ago, confirm a low level of compliance Limited awareness about the existence of standards. - Inappropriate standards across different contexts. - Limited understanding of universal design features. - Incompatible technology. - Prohibitive costs act as disincentives. An example of communication barriers are the trouble which Deaf people often have accessing sign language interpretation: a survey of 93 countries found that 31 countries had no interpreting service, while 30 countries had 20 or fewer qualified interpreters In the contemporary world, being able to use cell phones, and internet are increasingly vital. But often websites or devices are inaccessible, or the rapid pace of technological development means that new communication products are not compatible with existing assistive devices. Inaccessible environments and information make people excluded or dependent on others for assistance. But even an accessible environment can be rendered inaccessible when non-disabled people have negative attitudes towards people with disabilities – think of a bus driver who cannot be bothered to help a wheelchair user with a ramp or elevator.

Ambientes favorables problemas y desafíos
World Health Organization Las personas con discapacidad suelen no tener acceso a los medio de comunicación e información, por eso se habla de “brecha digital” en las TIC Las actitudes negativas pueden crear barreras incluso en la ausencia de barreras físicas. Environments (physical, social, attitudinal) can be enabling or disabling Unless people with disabilities can access buildings, transport and information, they cannot access healthcare or participate in schools, work or society. The key barriers which are reported include: Low level of compliance with laws on accessibility. Reports from countries with laws on accessibility, even those dating from 20 to 40 years ago, confirm a low level of compliance Limited awareness about the existence of standards. - Inappropriate standards across different contexts. - Limited understanding of universal design features. - Incompatible technology. - Prohibitive costs act as disincentives. An example of communication barriers are the trouble which Deaf people often have accessing sign language interpretation: a survey of 93 countries found that 31 countries had no interpreting service, while 30 countries had 20 or fewer qualified interpreters In the contemporary world, being able to use cell phones, and internet are increasingly vital. But often websites or devices are inaccessible, or the rapid pace of technological development means that new communication products are not compatible with existing assistive devices. Inaccessible environments and information make people excluded or dependent on others for assistance. But even an accessible environment can be rendered inaccessible when non-disabled people have negative attitudes towards people with disabilities – think of a bus driver who cannot be bothered to help a wheelchair user with a ramp or elevator.

Ambientes favorables: soluciones
World Health Organization Adoptar leyes y normas adecuadas Mejorar el nivel de cumplimiento: sensibilizar las partes interesadas sobre las leyes y normas, establecer mecanismos de seguimiento y de cumplimiento Adoptar los principios del diseño universal en los diseños y en las acciones de desarrollo, por ejemplo sistemas de autobús de tránsito rápido que promuevan en acceso de todo el mundo. Across domains, key requirements for addressing accessibility and reducing negative attitudes are appropriate laws, access standards; cooperation between the public and private sector; a lead agency responsible for implementation; training in accessibility; universal design for planners, architects, and designers; user participation; and public education. Experience shows that mandatory minimum standards, enforced through legislation, are required to remove barriers in buildings. A systematic evidence-based approach to standards is needed. Accessibility audits by disability organizations can encourage compliance. For developing countries a strategic plan with priorities and increasingly ambitious goals can make the most of limited resources. The 1% extra cost of access compliance in new buildings is cheaper than adapting existing buildings. Improved ICT accessibility can be achieved by bringing together market regulation and antidiscrimination approaches, along with relevant perspectives on consumer protection and public procurement. Countries with strong legislation and follow-up mechanisms tend to achieve higher levels of ICT access, but regulation needs to keep pace with technological innovation. In transport the goal of continuity of accessibility throughout the travel chain can be achieved by introducing accessibility features into regular maintenance and improvement projects, and developing low-cost universal design improvements that result in demonstrable benefits to a wide range of passengers. Accessible bus rapid transit systems are increasingly being adopted in developing countries.

Ambientes favorables: soluciones
World Health Organization Promover la difusión de información y la sensibilización al tema, por ejemplo a través de cursos de formación para arquitectos, diseñadores, ingenieros y otros profesionales y campañas de sensibilización para el publico general. Asegurar la participación del usuario en las fases de diseño, diagnostico, desarrollo y control Across domains, key requirements for addressing accessibility and reducing negative attitudes are appropriate laws, access standards; cooperation between the public and private sector; a lead agency responsible for implementation; training in accessibility; universal design for planners, architects, and designers; user participation; and public education. Experience shows that mandatory minimum standards, enforced through legislation, are required to remove barriers in buildings. A systematic evidence-based approach to standards is needed. Accessibility audits by disability organizations can encourage compliance. For developing countries a strategic plan with priorities and increasingly ambitious goals can make the most of limited resources. The 1% extra cost of access compliance in new buildings is cheaper than adapting existing buildings. Improved ICT accessibility can be achieved by bringing together market regulation and antidiscrimination approaches, along with relevant perspectives on consumer protection and public procurement. Countries with strong legislation and follow-up mechanisms tend to achieve higher levels of ICT access, but regulation needs to keep pace with technological innovation. In transport the goal of continuity of accessibility throughout the travel chain can be achieved by introducing accessibility features into regular maintenance and improvement projects, and developing low-cost universal design improvements that result in demonstrable benefits to a wide range of passengers. Accessible bus rapid transit systems are increasingly being adopted in developing countries.

Educación A pesar de la importancia de la educación, los niños con discapacidad pueden ser excluidos de las escuelas.

Educación l La educación inclusiva se basa en el derecho de todos los educandos a recibir una educación de buena calidad que atienda las necesidades básicas de aprendizaje y enriquezca la vida. Dirigida principalmente a los grupos vulnerables y marginados, procura desarrollar plenamente el potencial de cada persona

Educación: problemas y desafios
World Health Organization La educación es fundamental para que los niños con discapacidad puedan participar en el empleo y en otras esferas de la actividad social . Los niños con discapacidad tienes menos probabilidad que sus pares sin discapacidad de asistir a la escuela. Las tasas de matriculación también difieren según el tipo de deficiencia. A nivel sistémico, hay problemas de liderazgo, políticas y recursos. Despite the importance of education, children with disabilities are excluded from schooling. Data from Malawi, Namibia, Zambia, and Zimbabwe show that children with disabilities aged 5 years or older were 2 – 3 times more likely never to have attended school than non disabled children. The gap between the percentage of disabled children and the percentage of nondisabled children attending primary school ranges from 10% in India to 60% in Indonesia. Even in countries with high primary school enrolment rates, many children with disabilities do not attend school (see slide on outcomes). Enrolment rates also differ among impairment groups, with children with physical impairment generally faring better than those with intellectual or sensory impairments. For example in Burkina Faso in 2006 only 10% of deaf 7-to-12 year olds were in school, whereas 40% of children with physical impairment attended, only slightly lower than the attendance rate of non-disabled children. The costs of exclusion are enormous. In Bangladesh alone the cost of disability due to forgone income from a lack of schooling and employment, both of people with disabilities and their caregivers, is estimated at US$ 1.2 billion annually, or 1.7% of gross domestic product. The barriers preventing inclusion in education are: At the level of the system - Divided ministerial responsibility. For example, education for disabled children is responsibility for MoSW not MoE - Lack of legislation, policy, targets and plans. At the level of the school - Inaccessible curricula and pedagogy. - Inadequate resources. - Inadequate training and support for teachers. - Physical and attitudinal barriers. The report recommends inclusive schooling, because it supports CRPD principles and is cost-effective. When children with disabilities attend mainstream schools, this can reduce stigma and negative attitudes around disability as it promotes interaction between disabled children and their non-disabled peers. But there is no definitive evidence on outcomes.

Educación: problemas y desafios
World Health Organization A nivel escolar, los problemas consisten en actitudes negativas, falta de docentes, instalaciones inaccesibles, modelos pedagógicos y de evaluación inadecuados. La inclusión de los niños en las escuelas convencionales es deseable, sin embargo la evidencia disponible sobre el impacto del entorno sobre los logros académicos no permite conclusiones definitivas. Despite the importance of education, children with disabilities are excluded from schooling. Data from Malawi, Namibia, Zambia, and Zimbabwe show that children with disabilities aged 5 years or older were 2 – 3 times more likely never to have attended school than non disabled children. The gap between the percentage of disabled children and the percentage of nondisabled children attending primary school ranges from 10% in India to 60% in Indonesia. Even in countries with high primary school enrolment rates, many children with disabilities do not attend school (see slide on outcomes). Enrolment rates also differ among impairment groups, with children with physical impairment generally faring better than those with intellectual or sensory impairments. For example in Burkina Faso in 2006 only 10% of deaf 7-to-12 year olds were in school, whereas 40% of children with physical impairment attended, only slightly lower than the attendance rate of non-disabled children. The costs of exclusion are enormous. In Bangladesh alone the cost of disability due to forgone income from a lack of schooling and employment, both of people with disabilities and their caregivers, is estimated at US$ 1.2 billion annually, or 1.7% of gross domestic product. The barriers preventing inclusion in education are: At the level of the system - Divided ministerial responsibility. For example, education for disabled children is responsibility for MoSW not MoE - Lack of legislation, policy, targets and plans. At the level of the school - Inaccessible curricula and pedagogy. - Inadequate resources. - Inadequate training and support for teachers. - Physical and attitudinal barriers. The report recommends inclusive schooling, because it supports CRPD principles and is cost-effective. When children with disabilities attend mainstream schools, this can reduce stigma and negative attitudes around disability as it promotes interaction between disabled children and their non-disabled peers. But there is no definitive evidence on outcomes.

Educación: soluciones
World Health Organization Sistemas de educación inclusiva: adoptar legislación, políticas y planes nacionales apropiados. Enfoques centrados en los educandos: revisión de planes de estudio, métodos de enseñanza, sistemas de evaluación. Suministro de apoyo adicional: docentes de educación especial, auxiliares de apoyo, terapias The success of inclusive systems of education depends largely on a country’s commitment to adopt appropriate legislation, provide clear policy direction, develop a national plan of action, establish infrastructure and capacity for implementation, and benefit from long-term funding. Education systems need to adopt more learner-centred approaches with changes in curricula, teaching methods and materials, and assessment and examination systems. Many countries have adopted individual education plans as a tool to support the inclusion of children with disabilities in educational settings. Some children will require access to additional support services including specialist education teachers, classroom assistants, and therapy services. Appropriate training of mainstream teachers can improve teacher confidence and skills in educating children with disabilities. The principles of inclusion should be built into teacher training programmes and accompanied by other initiatives that provide teachers with opportunities to share expertise and experiences about inclusive education. Many of the physical barriers that children with disabilities face in education can be easily overcome, with simple measures such as changing the layout of classrooms. Finally, systematic collection of qualitative and quantitative data, which can be used longitudinally, is required for countries to map their progress and compare relative developments across countries .

Educación: soluciones
World Health Organization Fortalecimiento de la capacidad docente: capacitación profesional, apoyo, supervisión Eliminar las barreras físicas y superar las actitudes negativas Investigación: recopilación de datos cuantitativos y cualitativos The success of inclusive systems of education depends largely on a country’s commitment to adopt appropriate legislation, provide clear policy direction, develop a national plan of action, establish infrastructure and capacity for implementation, and benefit from long-term funding. Education systems need to adopt more learner-centred approaches with changes in curricula, teaching methods and materials, and assessment and examination systems. Many countries have adopted individual education plans as a tool to support the inclusion of children with disabilities in educational settings. Some children will require access to additional support services including specialist education teachers, classroom assistants, and therapy services. Appropriate training of mainstream teachers can improve teacher confidence and skills in educating children with disabilities. The principles of inclusion should be built into teacher training programmes and accompanied by other initiatives that provide teachers with opportunities to share expertise and experiences about inclusive education. Many of the physical barriers that children with disabilities face in education can be easily overcome, with simple measures such as changing the layout of classrooms. Finally, systematic collection of qualitative and quantitative data, which can be used longitudinally, is required for countries to map their progress and compare relative developments across countries .

Empleo La discapacidad no debe ser sinonimo de inhabilidad para trabajar.

Empleo Ajustes razonables pueden averarse necesarios para permitir a las personas con discapacidad de cumplir con su trabajo en igualdad de condiciones con los demás

Empleo: problemas y desafíos
World Health Organization Las personas con discapacidad presentan bajas tasas de participación en el mercado laboral Las tasas de ocupación difieren según el tipo de deficiencia Hay una diferencia salarial significativa entre hombres y mujeres con y sin discapacidad Overall, people with disabilities are more likely to be unemployed and generally earn less even when employed. (supporting information for Bullets 1 and 2) Global data from the World Health Survey show that employment rates are lower for disabled men (53%) and disabled women (20%) than for nondisabled men (65%) and women (30%). A recent OECD study (25) showed that in 27 OECD countries working-age persons with disabilities experienced significant labour market disadvantage and worse labour market outcomes than working-age persons without disabilities. On average, their employment rate, at 44%, was slightly over half that for persons without disability (75%). People with intellectual disabilities and people experiencing disability associated with mental health conditions have reduce economic opportunities. The Barriers which people with disabilities report in employment include: Lack of access: for example, limited education and training opportunities, and physical/ information barriers in the workplace, or in travel to work. Misconceptions about disability: for example, that PWD are less productive, or low expectations of PWD, or thinking that accommodations would be too complex and costly. Discrimination: particularly for people with mental health conditions or intellectual impairments.

Empleo: problemas y desafíos
World Health Organization La exclusión del mercado de trabajo es una de principales causas de pobreza. Barrera físicas y falta de transportes hacen mas difícil encontrar y retener un empleo. Actitudes negativas, ideas equivocadas sobre su productividad y discriminación limitan las oportunidades de las personas con discapacidad. Overall, people with disabilities are more likely to be unemployed and generally earn less even when employed. (supporting information for Bullets 1 and 2) Global data from the World Health Survey show that employment rates are lower for disabled men (53%) and disabled women (20%) than for nondisabled men (65%) and women (30%). A recent OECD study (25) showed that in 27 OECD countries working-age persons with disabilities experienced significant labour market disadvantage and worse labour market outcomes than working-age persons without disabilities. On average, their employment rate, at 44%, was slightly over half that for persons without disability (75%). People with intellectual disabilities and people experiencing disability associated with mental health conditions have reduce economic opportunities. The Barriers which people with disabilities report in employment include: Lack of access: for example, limited education and training opportunities, and physical/ information barriers in the workplace, or in travel to work. Misconceptions about disability: for example, that PWD are less productive, or low expectations of PWD, or thinking that accommodations would be too complex and costly. Discrimination: particularly for people with mental health conditions or intellectual impairments.

Empleo: soluciones World Health Organization Leyes y reglamentos: leyes contra la discriminación, acción afirmativa, cuotas Intervenciones especificas: incentivos para los empleadores, empleo respaldado, agencias de empleo, gestión de la discapacidad Promover el acceso a servicios de rehabilitación y formación profesional Antidiscrimination laws provide a starting point for promoting the inclusion of people with disabilities in employment. Where employers are required by law to make reasonable accommodations – such as making recruitment procedures accessible, adapting the working environment, modifying working times, and providing assistive technologies – these can reduce employment discrimination, increase access to the workplace, and change perceptions about the ability of people with disabilities to be productive workers. A range of financial measures, such as tax incentives and funding for reasonable accommodations, can be considered to reduce additional costs. In addition to mainstream vocational training, community-based vocational rehabilitation, peer training, mentoring, and early intervention show promise in improving disabled people’s skills. Community-based rehabilitation can improve skills and attitudes, support on-the-job training, and provide guidance to employers. User-controlled disability employment services have promoted training and employment in a number of countries. For people who develop a disability when employed, disability management programmes – case management, education of supervisors, workplace accommodation, early return to work with appropriate supports – have improved the rates of return to work. For some people with disabilities, including those with significant difficulties in functioning, supported employment programmes can facilitate skill development and employment. These programmes may include employment coaching, specialized job training, individually tailored supervision, transportation, and assistive technology. Where the informal economy predominates, it is important to promote self-employment for people with disabilities and facilitate access to microcredit through better outreach, accessible information and customized credit conditions. Mainstream social protection programmes should include people with disabilities, while supporting their return to work. Policy options include separating the income support element from the one to compensate for the extra costs incurred by people with disabilities such as the cost of travel to work and of equipment, using time-limited benefits and making sure it pays to work. The misconceptions about disability need to be constantly challenged by working with employers and the public.

Empleo: soluciones World Health Organization Desarrollar capacidades y promover el acceso a servicios de microfinancia Establecer planes de protección social, evitando crear desincentivos a la participación laboral Destruir las concepciones erradas sobre la discapacidad a través de iniciativas de sensibilización y contacto con los empleadores. Antidiscrimination laws provide a starting point for promoting the inclusion of people with disabilities in employment. Where employers are required by law to make reasonable accommodations – such as making recruitment procedures accessible, adapting the working environment, modifying working times, and providing assistive technologies – these can reduce employment discrimination, increase access to the workplace, and change perceptions about the ability of people with disabilities to be productive workers. A range of financial measures, such as tax incentives and funding for reasonable accommodations, can be considered to reduce additional costs. In addition to mainstream vocational training, community-based vocational rehabilitation, peer training, mentoring, and early intervention show promise in improving disabled people’s skills. Community-based rehabilitation can improve skills and attitudes, support on-the-job training, and provide guidance to employers. User-controlled disability employment services have promoted training and employment in a number of countries. For people who develop a disability when employed, disability management programmes – case management, education of supervisors, workplace accommodation, early return to work with appropriate supports – have improved the rates of return to work. For some people with disabilities, including those with significant difficulties in functioning, supported employment programmes can facilitate skill development and employment. These programmes may include employment coaching, specialized job training, individually tailored supervision, transportation, and assistive technology. Where the informal economy predominates, it is important to promote self-employment for people with disabilities and facilitate access to microcredit through better outreach, accessible information and customized credit conditions. Mainstream social protection programmes should include people with disabilities, while supporting their return to work. Policy options include separating the income support element from the one to compensate for the extra costs incurred by people with disabilities such as the cost of travel to work and of equipment, using time-limited benefits and making sure it pays to work. The misconceptions about disability need to be constantly challenged by working with employers and the public.

Recomendaciones generales
World Health Organization Permitir el acceso a todos los sistemas, las políticas y los servicios generales. Invertir en programas y servicios específicos para personas con discapacidad. Adoptar una estrategia y un plan de acción nacionales en materia de discapacidad. Involucrar a las personas con discapacidad The report concludes with 9 cross cutting recommendations. Implementing them requires involving different sectors – health, education, social protection, labour, transport, housing – and different actors – governments, civil society organizations (including disabled persons organizations), professionals, the private sector, disabled individuals and their families, the general public, the private sector, and media. It is essential that countries tailor their actions to their specific contexts. Where countries are limited by resource constraints, some of the priority actions, particularly those requiring technical assistance and capacity building, can be included within the framework of international cooperation. First recommendation is on mainstreaming: this is the process by which governments and other stakeholders address the barriers that exclude persons with disabilities from participating equally with others in any activity and service intended for the general public, such as education, health, employment, and social services. To achieve it, changes to laws, policies, institutions, and environments may be indicated. Mainstreaming not only fulfils the human rights of persons with disabilities, it also can be more cost-effective Second, in addition to mainstream services, some people with disabilities may require access to specific measures, such as rehabilitation, support services, or training. Third, a national disability strategy sets out a consolidated and comprehensive long-term vision for improving the well-being of persons with disabilities and should cover both mainstream policy and programme areas and specific services for persons with disabilities. The development, implementation, and monitoring of a national strategy should bring together the full range of sectors and stakeholders. Fourth, people with disabilities often have unique insights about their disability and their situation. In formulating and implementing policies, laws, and services, people with disabilities should be consulted and actively involved. Disabled people’s organizations may need capacity building and support to empower people with disabilities and advocate for their needs. Fifth, relates to training of healthcare workers, architects and other professionals, but also to ensuring availability of rehabilitation staff, sign language interpreters and support staff. Sixth, adequate and sustainable funding of publicly provided services is needed to ensure that they reach all targeted beneficiaries and that good quality services are provided. Seven, mutual respect and understanding contribute to an inclusive society. Therefore it is vital to improve public understanding of disability, confront negative perceptions, and represent disability fairly. Eight and nine emphasise the gaps in our knowledge about disability, the need for disaggregated data, the need for evidence on outcomes of interventions so we know what works. More researchers, including more researchers with disabilities, should be trained to conduct these studies.

Recomendaciones generales
World Health Organization Mejorar la capacidad de los recursos humanos. Suministrar financiamiento suficiente y mejorar la asequibilidad económica Sensibilizar más al público y mejorar su comprensión de la discapacidad. Mejorar la recopilación de datos sobre discapacidad. Reforzar y respaldar la investigación sobre discapacidad. The report concludes with 9 cross cutting recommendations. Implementing them requires involving different sectors – health, education, social protection, labour, transport, housing – and different actors – governments, civil society organizations (including disabled persons organizations), professionals, the private sector, disabled individuals and their families, the general public, the private sector, and media. It is essential that countries tailor their actions to their specific contexts. Where countries are limited by resource constraints, some of the priority actions, particularly those requiring technical assistance and capacity building, can be included within the framework of international cooperation. First recommendation is on mainstreaming: this is the process by which governments and other stakeholders address the barriers that exclude persons with disabilities from participating equally with others in any activity and service intended for the general public, such as education, health, employment, and social services. To achieve it, changes to laws, policies, institutions, and environments may be indicated. Mainstreaming not only fulfils the human rights of persons with disabilities, it also can be more cost-effective Second, in addition to mainstream services, some people with disabilities may require access to specific measures, such as rehabilitation, support services, or training. Third, a national disability strategy sets out a consolidated and comprehensive long-term vision for improving the well-being of persons with disabilities and should cover both mainstream policy and programme areas and specific services for persons with disabilities. The development, implementation, and monitoring of a national strategy should bring together the full range of sectors and stakeholders. Fourth, people with disabilities often have unique insights about their disability and their situation. In formulating and implementing policies, laws, and services, people with disabilities should be consulted and actively involved. Disabled people’s organizations may need capacity building and support to empower people with disabilities and advocate for their needs. Fifth, relates to training of healthcare workers, architects and other professionals, but also to ensuring availability of rehabilitation staff, sign language interpreters and support staff. Sixth, adequate and sustainable funding of publicly provided services is needed to ensure that they reach all targeted beneficiaries and that good quality services are provided. Seven, mutual respect and understanding contribute to an inclusive society. Therefore it is vital to improve public understanding of disability, confront negative perceptions, and represent disability fairly. Eight and nine emphasise the gaps in our knowledge about disability, the need for disaggregated data, the need for evidence on outcomes of interventions so we know what works. More researchers, including more researchers with disabilities, should be trained to conduct these studies.

De cara al futuro World Health Organization Planes de acción nacionales Leyes y políticas Informe Mundial sobre la Discapacidad Diálogos políticos nacionales Programas Regionales y Nacionales Servicios Capacitación Sensibilización Investigación This slide shows how the World Report on Disability will contribute to generating country level action. National launches or policy dialogues in countries will be the basis for developing or revising national plans of action with concrete actions and resource allocation to improve access to services, build capacity and raise awareness. These will develop country and regional programmes which can then be scaled up. WHO and the World Bank anticipate that the report through international policy dialogue will also help generate increased political will and raise awareness. It will also set the agenda for technical support activities. The large number of partners – WHO, DPOs, NGOs, professionals, development actors, academics - involved in the development of this report are also committed to supporting its implementation. Asistencia tecnica Diálogo político internacional

Resumen World Health Organization 1000 millones de personas Numeros crecientes Es posible superar las barreras El Informe Mundial nos muestra como Es el momento de actuar

El Informe Mundial sobre la Discapacidad: nuestro documento más accesible World Health Organization Braille archivo de audio Versión de fácil lectura PDF Accesible As well as being available in several other languages, the World Report on Disability is available in Braille, DAISY audio, accessible PDF and Easyread for people wanting a simplified version with pictures.

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