Reach: Accessibility in India and the challenges we still face

10 Nov 2010

This post shall be a work in progress. I’ll try to add more information to it when I can.

Accessibility is a loose term I’m going to use for level of reach required for basic needs and services, and how usable those are. I was in a conference once and a speaker asked ‘What do you understand by accessibility?’. An audience member who was himself unable to properly move, said “Its the ability to reach something”. To me that is what accessibility really is. If you can’t reach something, its not accessible to you. Education, infrastructure, employment, healthcare, the web, etc are all serious matters of accessibility, and care should be taken to make it reachable for all people. Also, care should be taken not only to make it within reach of everyone, but also to make sure it is properly usable by everybody, regardless ability or disability, so Usability is also important. With this post I would like to highlight the lack of proper access of even the most basic of things to disabled people in India.

##Awareness How aware are we in India when it comes to accessibility? Lets just say its definitely not enough. There is one camp which is quite aware towards the needs of PWDs. However, on the mass scale, the awareness just isn’t there. The people responsible for designing and implementing things are not aware of the needs of PWDs. We can see it in our buildings, toilets, employment statistics, and even our web sites…but more on that later. Let’s just look at the raw numbers first

##A few statistics Most of these are from a study conducted by the World Bank and the National Statistics Society and the World Health Organization. Some of them are from UNESCO and some from the various papers presented at Techshare Bangalore and Mumbai in 2008, including papers from SightSavers International and the Nina Foundation.

  • There are at least 650 million people with disabilities worldwide (thats around 10% of entire humanity), of whom approximately 80% live in less developed countries.
  • Worldwide, more than 161 million people are visually impaired; among them, 124 million have low vision and 37 million are blind.
  • More than 90% of the world’s visually impaired people live in low- and middle-income countries.
  • Medical causes of impairments are rapidly changing in India, from communicable diseases (earlier) to non-communicable disease and accidents (Present)
  • CWD(Children with disabilities) have a very high rate of drop out from school compared to other children.
  • PWDs have significantly lower employment rate and this gap has been INCREASING in the last 15 years.
  • India’s progress in some disabling diseases has been impressive in some cases (like polio vaccination program) but disappointing in others (like general health care)
  • Persons with Disability Act 1995, though groundbreaking, has weaknesses in design (like doesn’t recognize autism as a disability, among others)
  • 7% of Indian population is PWD (Which amounts to around 70 million people). This is according to the NCPEDP. According to the 2001 census it is 2% of the Indian population.
  • According to the 2001 census, seventy five per cent of persons with disabilities live in rural areas, 49 per cent of disabled population is literate and only 34 per cent are employed.
  • India has 12 million blind people, the highest in the world.

The good news even though the implementation may be uneven, at least the government is thinking on the right track. According to the National Policy for Persons with Disabilities the government now recognizes that certain disabilities can be treated and in a large number of cases are preventable. It also focuses on physical, economic and social rehabilitation of PWDs. Rehabilitation efforts include a focus on early detection, and appropriate medical facilities and care to PWDs.

##Healthcare and it’s impact on disability Lack of proper access to healthcare facilities may lead to an increase in disability related cases in a particular region. According to the World Bank study, children from poor households are at greater risk of malnutrition-induced disabilities. According to the latest NFHS study, Anaemia is widespread across the country, and around 70% of children between the ages of 6-59 months have it. Also access to care during pregnancy is quite poor. According the NFHS, Home births are still the norm. Seventy-two percent of women who gave birth at home said going to a health care facility is unnecessary, and 26 percent said it is too expensive. Factors such as malnutrition, and lack of access to proper health care facilities for pregnant women increase the chances of disability in babies.

Cataract is the main cause of blindness in India. Apparently around 62% of cases in India regarding blindess are cataract related. The government is also undertaking programs such as the National Programme for Control of Blindness. This is centrally funded, and provides for Cataract surgeries, eye screening in schools, collection of eye donations, training for opthalmic surgeons and support to related voluntary organizations.

The main cause of locomotor disabilities in India is still Polio. Our polio eradication programme has been quite effective, but still needs a long way to go in terms of education and outreach, especially amongst the uneducated areas. “Western Uttar Pradesh is the hardest place in the world to eradicate polio,” says Dr. Hamid Jafari, project manager of the World Health Organization’s polio eradication program in India. More on this in this article.

In fact you can see the state of Uttar Pradesh leading when it comes to the number of disabled people in India. Its not just because of the fact that it is the most populated state, but also because many pockets have lack of basic civic and medical infrastructure. Everyone knows that lack of basic sanitation facilities and access to clean water can result in the spread of Polio in regions in which it is not fully eradicated. An NHFS study found that around 74% of rural households do not have proper sanitation facilities and around only one-third of households boil their water or use other methods to make the water safer to drink. In a country like India, that has the potential to be very harmful.

##Mental Health and Emotional Support In my opinion mental health is one of the most neglected aspects of health in India. In many cases, mental illness or problems are not diagnosed as such, rather they are looked upon as rebellion, stupidity, an attitude problem or just a phase in life that the person is expected to move out of later. In some cases, mental illnesses can become disabling, preventing people from performing simple basic tasks related to self care, communicating with others and performing daily work related tasks for their livelihood. In this sense, people fail to realize that mental problems can also be disabling. People don’t pay attention to it, as its not something immediately noticed, its not contagious and the social stigma in India is much higher.

In 2002, the Government of India accepted the Indian Disability Evaluation and Assessment Scale (IDEAS) to be the scale by which mental disabilities would be measured. This is a step in the right direction. According to some research, medium/long term schizophrenia is a major disabling mental illness found more in the rural Indian areas, where medium/long-term OCD is found more in Indian urban areas. These and others, but especially schizophrenia cause major impediments in daily functioning.

Cognitive or learning disabilities are even less noticeable and fly below the radar of most teachers. According to this article, around 10% of children in indian schools have a learning disability. ADHD and other learning disorders are grossly under-recognized in India. Recently, a bollywood film was made highlighting the issue of Dyslexia, which has done quite a lot in increasing awareness of this issue, but we cant make a bollywood film for every disorder, and as such, raising awareness and training of teachers to deal with children with learning disorders is a serious challenge facing us.

When it comes to emotional support, it seems to be one of the most important things contributing towards the success of PWDs in their careers. All of the PWDs I have met who are doing well, all of them thank the support of their relatives and people in their work environment. In fact, emotional support is important for just about everyone, but when you have some ‘disability’, then having an unsupportive family or work environment can make the task of having a successful like and career even more of a challenge.

Unsupportive family environments can lead to lack of self-confidence in the disabled person. Families can also tend to be blatantly more supportive to other member of the family, thus once again leading to self-esteem issues in the person. On the flip side, one complaint I have heard often with many PWDs is that their family members can at time be over-protective and this could lead to, once again self-confidence issues, and lack of a feeling of independence for the PWDs.

##Building and Transport Infrastructure The Persons with Disability Act 1995 mandates that public places, especially educational institutions, should be made disabled friendly. ‘CPWD Guidelines for Barrier Free Built Environment and Space Standards for Disabled and Elderly’ also provide guidelines. I have been to countless public places even educational institutions which are in gross violation of it. In fact, a lot of these are even quite difficult for able bodied people to access (for e.g, Long flights of stairs which can make people, especially old people tired by the time they reach the top, etc). NCPEDP conducted an audit of five colleges in Delhi, and found glaring inadequacies in their implementation to provide a disabled friendly environment.

The disability act also requires public transportation to be non-discriminatory to disabled people. Even in this regard, we are woefully inadequate. Most common modes of public transport do not keep in mind disabled people, especially people using a wheelchair. Most buses, rickshaws and auto rickshaws in India are not friendly towards people on wheelchairs.

Even if ramps are provided somewhere, a major complaint is that those ramps are not properly built. Some are rickety and anyone using it would be a bit scared. Some have an extreme angle, which makes going up and down the ramp a challenge.

However, the Delhi Metro is a welcome change, and provides a range of features for helping PWDs in public transport. They have accessible toilets, ramps for entry, wide doors for lifts, etc. Sadly, examples of public transport systems having this kind of adaptability for PWDs are rare to find, even though there is some who suggest that the Delhi Domestic Airport and Dilli Haat have also been made PWD friendly. I’ve recently seen disabled friendly toilets in the Delhi Railway Station, and the new green buses in Delhi (these ones) also have facilities for wheelchairs. But one more thing to worry is that most of these places you will see will be in major urban centers, whereas most PWDs in India live in rural areas or areas which are not major urban hubs.

##Technological Innovation The real innovation which will come out of India would be about using local material found in abundance and using it to produce assistive tools which can be made relatively cheaply. This is the only kind of stuff that could work on a mass scale. There is no dearth of expensive assistive technological products, the problem is the market for it will be quite low as most disabled people in India are simply not affluent enough to afford it.

Take for example JAWS. It costs around Rs 60,000. Not a lot of people can afford that kind of money for personal use. Hence most of the people I have interacted with who are familiar with JAWS are familiar with it only through work, as their companies have bought the JAWS license for them.

A slightly less expensive option would be the ‘Dolphin Pen’ being developed. You can find more info on it here. So far it works only one Windows. Hopefully it will work on Linux and Mac in the future as well.

Ketna Mehta of the Nina Foundation gave a talk in Mumbai about the innovation happening in this space in India. She talked about a wheelchair being developed made almost completely out of bamboo. Bamboo is a very cheap and abundant resource available in the north east of India, and hence makes sense for it to be developed there cheaply. Other interesting stuff includes the Glabenator, a device which senses the movements of the muscles above the eyebrows. I also heard of a device operated by a blow switch - people could blow air into a pipe-like device and produce certain commands. This could be quite useful for people with neck-down paralysis. Other countries, are also doing similar stuff, so India is not alone. Also, most of the research and development being done in this area seems to be only from the IITs (from what I’ve heard).

##Education First off, physical access to schools is limited for CWDs. Physical access not just in the sense of proximity of the school to the home, but also access to basic facilities like proper toilets and good blackboards with proper contrast, ramps for children with motor disabilities, etc.

Children with disabilities in the age group of 15-18 years are provided free education under Integrated Education for Disabled Children (IEDC) Scheme. The ‘Sarva Sikhsha Abhiyan’ also has in place measures for Inclusive Education for disabled children. The PWD act mandates that all CWDs have right to free education till the age of 18.

The NCPEDP conducted a survey of schools, colleges and universities in India regarding their approach and enrollment of PWDs. The results were highly disappointing indeed. Out of the 318 schools contacted, only 89 responded. The rest I guess, did not even care to fill up the questionnaire which tells us about the state of mind in those school administrations. Out of those which responded, it was found that the number of CWDs in those schools was around 0.51%.

The PWD act states ‘all Government educational institutions and other educational institutions receiving aid from the Government, shall reserve not less than three per cent seats for persons with disabilities’. This is hardly followed in our universities. However, the survey found only 0.1% of students were PWDs. Of the types of disabilities of PWDs enrolled in those universities, it was found that most were locomotive, then visual, then hearing and then mental disabilities. This closely mimics the employment trends among PWDs in India. Seven universities clearly mentioned that they do not admit students with disabilities! On the flip side, Osmania University was leading the pack in providing adequate support for students with disabilities. They enrolled 60 PWDs. However, considering its size, the number is still very very low. Banaras Hindu University and Aligarh Muslim University had PWD students in double digits(more than 200 such students), but were not providing any kind of special equipment to those students.

It would be fair to say that our policies regarding education for children with disabilities in India are pretty sound, however the implementation is quite poor, and is this is especially true in the case of higher education in this country.

##Employment Do PWDs get access to proper employment opportunities in India? According to studies by both the World Bank and the NCPEDP, it is quite low, but it actually depends on what condition you are talking about. In general, the rate of employment with motor disabilities is highest, and people with mental disabilities lowest. According to an NCPEDP survey of 70 major Indian companies, 20 did not even employ one single PWD. The ones which did, had abysmally low PWD employment rates (between 0.01 percent to 0.09 percent). For example, Hindustan Motors, with employee strength of 40,000 employed only 4 PWDs. The percentage of PWD employed in the public sector was the highest, followed by the private sector. Multinationals had really low rate of 0.05%.

Having said that, there are a few private and multinational companies doing commendable work in regards to PWD employment. TCS Maitree is a program run by TCS which is aimed at employing people with visual impairments. IBM-India has won laurels for its adaptability for PWDs within its workforce. I personally have met a visually disabled person who works at IBM and was happy with the working conditions and support provided to her there.

One aspect in which organizations try to convince companies to hire PWDs is Employee Retention. Usually PWDs are much less willing to shift and change their place of work if they find the work environment comfortable. This means greater employee retention for companies. Companies need to realize that PWD employees are as good as other employees, and are able to achieve the same amount of progress in their work as others. I’ve met a number of people working in the software industry, a person working in the Indian Economic Services, freelancers, a librarian, university professors, and more who are doing a heck of a job in their respective fields.

The government of India has also given an incentive to employ PWDs by sponsoring their provident fund and the state insurance for the first 3 years. Besides that, the Disability Act provides a reservation of 3% to PWDs. The Finance Minister has announced to provide jobs to 100,000 PWDs by the end of the financial year. Lets hope we don’t yet again encounter a disconnect between announcements and implementations.

##Web Accessibility This is a presentation I gave at Techshare Mumbai. It introduces people to standards and the importance of valid code, and goes on to introduce our work on Opera MAMA, where we find out that only a few people (relatively speaking) are actually writing valid code. Then its on to Indian web sites, and I argue with examples (just to illustrate the pitfalls we still fall into) that many of the biggest and most important Indian web sites do not care or are unaware about web accessibility.

As you could see from the presentation, writing valid code is important as it makes your code easier to maintain. But more importantly, it becomes easier to read (not just humans, but also screen readers and search engine spiders). In general, valid code is automatically much more accessible than invalid, non-standard code.

Indian web sites, in general, have not really matured much and have the same disrespect for the user as ten years ago. Same frequent popups, intrusive ads, many of which are blinking at such a rate that may cause seizures. Marquees are still prevalent, even though not as much as ten years ago. Most marquees still can’t be paused or stopped.

Most government sites are still coded in tables, and they look like they’ve been stuck in a time warp from the 90s. In fact, my opinion is that they probably haven’t been updated in terms of design ever since their creation in the 90’s/early 2000s. Only the content has been updated, and many times you will find that even the content is old.

Another problem is that sites, especially Indian news and religious sites, use EOT fonts to display regional characters in Hindi, Telegu, etc. The problem with EOT fonts are that they can only be seen on Internet Explorer. That means people using other browsers, and people on operating systems other than windows cannot view the text in the site. Many sites use PFR, which is equally non accessible. But the biggest flaw I’ve seen is sites just writing regional content and then displaying it as an image file!

The best way to display regional fonts is to use Unicode (UTF-8). If not, then use downloadable fonts, and if not that, then you could even use web fonts (web fonts support is still being implemented in a number of browsers, but at least its a standard compliant way). I’ll post more on this later on. Thankfully, I’m seeing a decline in the number of sites using EOT and an increase in sites using Unicode to display regional fonts. But there still are a number of sites which are made inaccessible to other browsers and OSs because of EOT.

My main point in the presentation was though, that if Indian developers do not even see the value in writing valid code, they will never get to the point of following something like the WCAG 2.0 accessibility guidelines. So the first step for all of us is to make sure the developers are aware of the value of writing standards compliant, valid code. This will in itself make their pages more accessible. Later on we can teach them about accessibility and everything else. The first step is to ensure developers write valid, standards compliant code.

During the presentation, I asked the audience of what the web meant to them? A number of people answered, but the one person I remember the most was an audience member who was in a wheelchair and had difficulty speaking properly (She has a very sharp mind and is a QA engineer for a software company). She spoke with all her strength and said ‘The web is my window to the outside world’.

In some of my next posts, I will highlight some of the good work and success stories in this field.

##Links and references

PWD: Persons with disabilities. (I use this for lack of a better phrase)

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