Child Poverty Measurement: the Case of Afghanistan

This paper examines child poverty from a multidimensional perspective. The main goal is to apply a general methodology in order to measure child poverty as a deprivation of capabilities and achieved functionings. In the capability perspective, child poverty is intended as the lack of freedom to choose to do and to be what children have reason to value. Although the various approaches to conceptualising, defining and measuring poverty, several researchers underline the need for children to be separated from their adult nexus, and treated according to their own specificities. The case study is focused on Afghan children, and it is based on a survey carried out by Handicap International that took into consideration many dimensions of children’s wellbeing, including concepts that are usually missing in standard surveys.Afghanistan, Multidimensional poverty measurement, Capability Approach, Children

Extending the capability paradigm to address the complexity of disability

Amartya Sen looks at people’s well-being in terms of functioning and freedom, rather than in terms of the amount of goods or services consumed. The capability approach developed by Sen deals with what people are able to achieve by using these commodities. Concerning disability, he wrote: “We must take note that a disabled person may not be able to do the many things that an able-bodied individual can, with the same bundle of commodities” (Sen, 1985 p.7). The capability approach makes it possible to analyse the economic situation of people with disabilities in a different way. What becomes important is their functioning, i.e. what they are able to achieve within a given context. In fact, the capability set includes not only what a person is effectively able to achieve, but also the potential functionings that he/she can choose. This expresses the degree of freedom that a person with disability benefits from in a given environment. The challenge is therefore to reduce the constraints that the environment adds to a person’s impairment in order to expand their capability set, and to allow them to live a life which they value. This paper reviews the paradigms that address disability and the ways of assessing a person’s capability set within this framework. Achieved functionings are easily measured through cross-sectional surveys, using counterfactual analysis to compare the situations of disabled and non-disabled people. This was done in 2005 in Afghanistan when a national disability survey was carried out on a random sample of households. Measuring detailed capabilities, especially their freedom dimension, is quite complex and requires identifying people’s potential choices in an ever-changing environment. This implies a need to extend the philosophical framework, and to adopt appropriate statistical methodologies

Challenges for assessing disability prevalence: the case of Afghanistan = Les défis de la mesure de la prévalence du handicap : le cas de l’Afghanistan

This article attempts to examine the methodological intricacies of measuring prevalence rate of disability through a population based survey using the International Classification of Functioning, Disability and Health of the WHO and the Capability framework, developed by Amartya Sen and others. After a rapid overview of the Afghan context and the process leading to the research programme, it presents the example of the methodology used in the NDSA and the survey protocol. The authors argue that prevalence rates can be measured using different instruments in terms of impairments, activity limitations or in terms of well-being. Thus, the disability experience is measured through a multidimensional approach. The article concludes that whatever the conceptual framework adopted, understanding the situation of persons with disability requires to go beyond measurement of disability prevalence. It implies to look at the links between disability prevalence and the persons’ valuable functioning’s and social agency, in a given environment, using other variables made available by the survey

Vulnerability and mental health in Afghanistan: Looking beyond war exposure

This study examined the prevalence of mental distress among groups in Afghanistan considered to be at risk. Data were drawn from a representative cross-sectional disability survey carried out in Afghanistan including 5,130 households in 171 clusters throughout the 34 provinces of the country. The sample included 838 non-disabled control participants aged above 14, and 675 disabled participants. Results showed that various vulnerable groups (disabled people, the unemployed, the elderly, minority ethnic groups, as well as widowed, divorced or separated women) were at higher risk of experiencing mild to severe mental health problems. The adjusted odds ratio for war-related disability compared to non-disabled was 4.09 (95% confidence interval 2.09 to 7.99) for mild mental distress-disorders, and 7.10 (3.45-14.5) and 14.14 (3.38-59.00) for moderate or severe mental distress-disorders, respectively. Women with disabilities (whatever the cause of impairment) when compared with non-disabled men, as well as poorer segments of society compared to the richest, had a higher prevalence of mental health problems. Women with non-war-related disabilities compared with non-disabled men were respectively 3.35 (1.27-8.81) and 8.57 (3.03-24.1) times more likely to experience mild or moderate mental distress-disorders. People who experience multiple vulnerabilities are more at risk of deteriorating mental health in conflict zones. The study shows that mental health, in times of war, is influenced by a combination of demographic and socioeconomic characteristics linked to social exclusion mechanisms that were in place before the conflict began and that are re-defined in relation to the changing social, cultural, and economic contexts. Mental health policies and programmes remain must prioritise the most vulnerable segments of Afghan society

Challenges for assessing disability prevalence: the case of Afghanistan = Les défis de la mesure de la prévalence du handicap : le cas de l’Afghanistan

This article attempts to examine the methodological intricacies of measuring prevalence rate of disability through a population based survey using the International Classification of Functioning, Disability and Health of the WHO and the Capability framework, developed by Amartya Sen and others. After a rapid overview of the Afghan context and the process leading to the research programme, it presents the example of the methodology used in the NDSA and the survey protocol. The authors argue that prevalence rates can be measured using different instruments in terms of impairments, activity limitations or in terms of well-being. Thus, the disability experience is measured through a multidimensional approach. The article concludes that whatever the conceptual framework adopted, understanding the situation of persons with disability requires to go beyond measurement of disability prevalence. It implies to look at the links between disability prevalence and the persons’ valuable functioning’s and social agency, in a given environment, using other variables made available by the survey

Poverty and disability: A vicious circle? Evidence from Afghanistan and Zambia

Disability and poverty have a complex and interdependent relationship. It is commonly understood that persons with disabilities are more likely to be poor and that poverty may contribute to sustaining disability. This interdependency is revealed not only through an examination of poverty in terms of income but also on a broader scale through other poverty related dimensions. Just how robust is this link? This paper compares data collected from household surveys in Afghanistan and Zambia, and explores the potential link between multidimensional poverty and disability. We find evidence of lower access to health care, education and labour market for people with disabilities, whatever is the disability status, but poverty measured by an asset index is not statistically different between people with and without disabilities

\u27Delivering\u27 Education; Maintaining Inequality. The case of children with disabilities in Afghanistan

Education for children with disabilities in Afghanistan, particularly disabled girls, continues to lag behind despite laudable efforts of the Ministry of Education to promote universal access for all. The opportunity for education constitutes not just a means of achieving learning outcomes but also a space for social interaction, individual development and psychosocial support, which are paramount in Conflict Affected Fragile States (CAFS). However, many persisting barriers still need to be overcome in Afghanistan to allow education for all and change negative attitudes towards education of children with disabilities. In this paper we argue that viewing education as a basic commodity, which is the widespread practice in CAFS, is not conducive to expanding human freedoms and capabilities. More specifically, through analyses of a national survey, we demonstrate that despite considerable resources, increasing access to education in Afghanistan has maintained processes of marginalization of the already excluded

Measuring equity in disability and healthcare utilization in Afghanistan

This paper analyses equity in health and healthcare utilization in Afghanistan based on a representative national household survey. Equitable access is a cornerstone of the Afghan health policy. We measured socioeconomic-related equity in access to public health care, using disability– because people with disabilities are poorer and more likely to use health care – and a concentration index (CI) and its decomposition. The socioeconomicrelated equity in healthcare utilization was measured using a probit model and compared with an OLS model providing the horizontal inequity index (HI). We found low rate of healthcare facilities utilization (25%). Disabled persons are using more healthcare facilities and have higher medical expenses. Disability is more frequently associated with older age, unemployed heads of household and lower education. The CI of disability is 0.0221 indicating a pro-rich distribution of health. This pro-rich effect is higher in small households (CI decreases with size of the household, -0.0048) and safe (0.0059) areas. The CI of healthcare utilization is -0.0159 indicating a slightly pro-poor distribution of healthcare utilization but overall, there is no difference in healthcare utilization by wealth status. Our study does not show major socioeconomic related inequity in disability and healthcare utilization in Afghanistan. This is due to the extreme and pervasive poverty found in Afghanistan. The absence of inequity in health access is explained by the uniform poverty of the population and the difficulty to access BPHS facilities, despite alarming health indicators