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Living conditions among people with activity limitations in Zimbabwe. A representative regional survey
Southern Africa Federation of the Disabled (SAFOD)
December 2003

http://www.safod.org/Images/LCZimbabwe.pdf

Summary
This representative study on living conditions among people with disabilities in Zimbabwe is the result of an international co-operation between Southern Africa Federation of the Disabled (SAFOD), Norwegian Federation of Organisations of Disabled People (FFO), University of Zimbabwe (Medical School; Department of Psychiatry and Department of Rehabilitation), and SINTEF Unimed. The study has been funded by the Atlas Alliance on behalf of Norwegian Agency for Development Co-operation (NORAD). In addition to the study itself, a capacity building component has been an important part of the collaboration.

Forming part of a Regional initiative to establish baseline data on living conditions among people with disabilities in Southern Africa, the study in Zimbabwe is the second to be published. The report, though largely descriptive, also comprises bivariate and multivariate analyses. Further results from the study will be presented later in more focused scientific publications.

The study design was developed in close collaboration with a broad range of stakeholders. Organisations of people with disabilities and individuals with disabilities have played a particularly active role during development of the design as well as in the data collection. Based on previous studies in the Region, the research instrument comprises a study on living conditions among households with and without disabled members, a screening instrument (for disability), a section with specific questions to individuals with disabilities, and a matrix that represents an operationalisation of core concepts from the International Classification of Functioning, Disability and Health (ICF).

A two-stage stratified sampling was carried out with enumeration areas as strata. A total of 1943 households with disabled members and 1958 households without disabled members were sampled in three regional areas: Matabeleland, Manicaland and Midlands.

A comparison with results from the Namibia study is included for some major indicators. In general, the patterns observed (both similarities and differences) between people with and without disabilities demonstrated in Namibia were replicated in Zimbabwe. It is however worth noting that some of these differences tended, on a few important indicators, to be weaker in Zimbabwe than those seen in Namibia.

The study design allows for the following types of comparisons: between individuals with and without disabilities, and between households with and without disabled members. With regards to demographics, households with disabled members were found to have higher mean age and they were larger, having more children than did control households. These and other socio-demographic differences may be the result of certain coping mechanisms that have been established in households with disabled members, mechanisms intended to cater particularly to the increased care duties found in these households.

In Zimbabwe, the study has been carried out as three consecutive surveys in three regions covering 44 % of the population. The reason for this step-wise procedure is found in the rather difficult political and economic situation in Zimbabwe during the research period. Due to time and financial constraints, the entire country could not be surveyed. Although this is a weakness as compared to a full National study, it is reassuring that the results from the three regional studies are for the most part similar. It is thus likely that including more regions in the study would not uncover new patterns, particularly not with respect to the main results.

School attendance as well as performance (measured as school grade completed) is clearly lower among persons with disabilities. Among children 5 years of age or older, 27.9 % of those with disabilities had never attended school, while the corresponding figure for non-disabled was 10.1 %. Among those who had attended school, 24.4 % of those with disabilities had completed 8th – 12th grades as their highest grade, while the corresponding figure for non-disabled was 32.3 %.

Unemployment is high in Zimbabwe. No significant difference was however found between disabled and non-disabled, reflecting possibly that an extensive system of specialized services for individuals with disabilities, in particular employment opportunities in sheltered workshops, have existed in the country since 1950’s. It was further shown that mean monthly salary among those who work is not affected by a disability status.

Comparison between the two types of households revealed expected differences, although not with regards to economy and work. On many other indicators on level of living, households with disabled members did however score lower than the control households. This goes for housing standard, access to information, and to some extent also for measures of income. An important reason for this difference is very likely that more households with disabled members reported that no one in the household was gainfully employed. The study also revealed that 12.5 % of respondents with disabilities received financial assistance through a disability grant or pension, mostly a disability grant from Department of Welfare. One fifth of those who received grants had an old age pension. These figures are lower than in Namibia and may contribute to balance somewhat the impression that individuals with disabilities are comparatively better off in Zimbabwe.

Disability was found to be evenly spread with respect to age. This profile results from the demographic situation in Zimbabwe with more than half the population being under 20 years of age and relatively fewer in the 50 + age ranges. Around 45 % of those with disabilities had mobility difficulties

(major or minor disability, paralysis), one third reported sensory impairments, while intellectual disabilities, learning disorders and emotional disorders accounted for 11 % of reported cases. It is interesting to note that this is very close to the corresponding profile for Namibia. The major causes of disability were reported to be either the result of illness, birthrelated or congenital, and accidental. Close to half of the respondents reported onset of disability before the age of 5 years, indicating a serious challenge to health services for mothers and children in the country.

Among services available to persons with disabilities, health services were found to be available for the large majority of people with disabled, with more than 90 % of those who needed this service having actually received it. The most noticeable shortcomings with regards to service provision were vocational training, assistive devices, welfare services and counselling services. The first two were received by less than one fourth of those who claimed that they needed them.

An assessment of various forms of assistance that may be needed by individuals with disabilities in performing daily life activities showed that a large majority of respondents claimed to need emotional support, surpassing by far all other types of assistance required. Economic support, or assistance with finances, was the second most often mentioned form of assistance needed. It is interesting to note that, within the family, the role of the individual with a disability does not appear to be much affected by their disability status.

While an overview of accessibility to different services, facilities and institutions gives a mixed picture, it is clear that certain of these facilities are not generally accessible to all. Hotels, workplaces, magistrate offices, recreational facilities and banks are all accessible to less than 30 % of individuals with disabilities. Health care clinics, hospitals and public transport are on the other hand reported to be accessible by the large majority. The mixed picture demonstrated with regards to accessibility indicates that the potential exists for improving accessibility for people with disabilities.

Assistive devices are used by a little more than one fourth of those surveyed with disabilities. Again it is interesting to note that this figure is higher than the corresponding figure for Namibia (< 20 %). It is further shown that most of the devices in use are functioning well, that many have received instructions on how to use them, but that only a small portion of devices are maintained professionally. In Zimbabwe, the supply of devices is apparently balanced between private and public sources. Compared with Namibia, a higher share of devices is supplied by private sources in Zimbabwe, reflecting the strong tradition of privately initiated and organised services for individuals with disabilities in the country.

A matrix was developed and applied to map an individual’s activity limitations and participation restrictions according to different parameters, domains or life situations (sensory experiences, basic learning and applying knowledge, communication, mobility, self care, domestic life, interpersonal behaviours, major life areas and community, social and civic life). It was found that individuals with mental/emotional impairments needed more help in their daily activities than did those in other disability categories. This group also reported more activity limitations and restrictions in social participation than others. Individuals with mental/emotional problems thus reported that they experience more barriers to full participation in society.

Activity limitation and participation restriction scores are higher in urban than in rural areas, indicating that complex societies in a sense produce disability. A further indication of this finding is reflected in the finding that needs for services were reported to be higher among those who attend school or are employed. Assessing the constructed indices based on activity limitations and participation restrictions with respect to indicators of living conditions revealed that both indices were associated with indicators on level of living. The more severe an individual’s disability is as measured through limitations in daily life activities and restrictions in social participation, the lower the level of school attendance and employment.

The baseline data and results produced through this study can be applied later for monitoring purposes. Results can be applied directly as documentation of the standard of living among people with disabilities and their families, and as a basis for comparison with non-disabled individuals and families without a disabled family member. This information is potentially useful when decisions are made on utilisation of meagre resources, as documentation and evidence to prospective donors or other funding sources, and as a tool for organisations of disabled people in setting priorities, educating their own members and the population in general, and as a basis for advocacy.

It is recommended that the results from this study are considered, together with other relevant sources, as a basis for dialogue between authorities, professionals and organisations of people with disabilities, for setting priorities, and for developing concrete measures within selected areas of priority.

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