2016年-世界发展银行全球_Disability_in_the_Palestinian_Territories___Assessing_Situation_and_Services_for_People_with_Disabilities_88页_1mb

Summary of the World Bank Assessment on Disability in the Palestinian Territories

Core Content

This World Bank document assesses the situation and available services for people with disabilities (PWD) in the West Bank and Gaza, focusing on the challenges and opportunities for improving their inclusion and access to essential services. The assessment was commissioned by the Ministry of Social Affairs (MOSA) to support the reform of the Cash Transfer Program (CTP) and to inform policy decisions for the broader disability sector.

Main Elements of the Assessment

Disability Profile and Context

• Prevalence: The disability prevalence rate is reported at 7%, but is likely severely underestimated due to cultural, social, political, and technical factors.
• Mobility Disability: Accounts for about 48.4% of all PWD, making it the most common type.
• Age and Gender: Disability rates are significantly higher among individuals aged 75 years and above (32.0%), with females (34.1%) showing higher rates than males (28.9%). Among children, the rate is 1.5%.
• Education and Employment: Around 37.6% of PWD aged 15 and above have never been enrolled in school. Employment rates are very low, with 87.3% of PWD not employed overall, and 90.9% in Gaza not employed.
• Historical Context: The disability movement in Palestine began in the 1990s and has seen a renaissance since the adoption of the UN Convention on the Rights of Persons with Disabilities (CRPD).

Strategic Inclusion Action Agenda

The assessment outlines a strategic agenda for the inclusion of PWD, emphasizing a twin-track approach that combines mainstream and support services. The framework is based on the 4 As—Availability, Accessibility, Affordability, and Accountability.

Key Recommendations

1. Immediate Actions (12–24 months): Focus on modernizing institutional structures, reviewing disability classification, consolidating data, and clarifying gatekeeping procedures.
2. Medium-Term Actions (2–4 years): Aim to remove basic obstacles to social and economic independence through sector reforms and improved coordination.
3. Long-Term Agenda: Promote universal access to public facilities and transport, and involve all stakeholders in the design and implementation of inclusive infrastructure.

Key Challenges Identified

• Availability: Significant gaps exist in services for hearing, intellectual, and severe disabilities. Mobility and support devices are least addressed, yet most critical.
• Accessibility: Physical access to infrastructure and services is limited, especially in Gaza. Inaccessible transport and non-transparent eligibility criteria hinder access.
• Affordability: Many services are provided by NGOs and the private sector at high costs, which PWD often cannot afford. There is no system to address these extra costs.
• Accountability: Service providers and decision-makers lack awareness of regulations and accountability mechanisms. There is no efficient monitoring and evaluation system, and complaint mechanisms are often inaccessible or ineffective.

Funding and Institutional Support

• Funding: No clear financing strategies or budget allocations for PWD services. NGOs and INGOs are the main funders, with an estimated budget of US$5 million for this year.
• Institutional Support: The MOSA, MOH, MOEHE, and MOL have not developed clear policies or programs for PWD. The CRPD principles are not fully integrated into the legal and institutional frameworks.
• Gatekeeping: The current disability certification process is based on outdated medical criteria (ICD-10) and does not consider daily activities or environmental factors. Referral mechanisms are ad hoc and lack transparency.

Knowledge Gaps

• Data Inconsistencies: There are significant gaps in data collection and management, especially in sectoral data, which is not systematically collected as part of national strategies.
• Classification Issues: The disability classification and certification process is corrupt and outdated, leading to underestimation of the disability situation.
• Geopolitical Constraints: Limited access to information and informants due to the tight timeframe and regional instability.

Regional Differences

• West Bank and Gaza: While both regions follow similar legal frameworks, differences exist in the availability, accessibility, and affordability of services. Coordination between the two is weak.
• Service Disparities: Gaza has its own Medical Committees for disability assessments, which do not coordinate with the West Bank system. Some services in the West Bank are not accessible to PWD in Gaza.

Conclusion and Recommendations

• Holistic Approach: Cash transfers alone are not sufficient. A comprehensive, service-oriented approach is necessary to meet the needs of PWD.
• Policy Integration: The CRPD should be integrated into all relevant policies and strategies to ensure rights-based approaches.
• Collaboration: Improved coordination between ministries, NGOs, and international donors is essential.
• Capacity Building: Training and awareness programs for decision-makers and practitioners are needed to address biases and improve understanding of disability.

Key Players and Stakeholders

• State (local and national): Key in policy development and implementation.
• Service Providers: Include both public and private entities, often operating without clear regulations.
• PWD and Their Representatives: Should be actively involved in service monitoring and evaluation.
• International Donors and NGOs: Play a significant role in funding and supporting disability services.

Future Steps

• Modernize Disability Classification: Use WHO's ICF framework.
• Improve Data Collection and Management: Ensure consistency and reliability.
• Enhance Gatekeeping Procedures: Make them transparent and standardized.
• Promote Inter-sectoral Collaboration: Across education, health, and labor sectors.
• Strengthen Accountability Mechanisms: Including complaint and appeal systems.

Final Note

The assessment highlights the need for a more inclusive, rights-based, and sustainable approach to disability services in Palestine, with a focus on improving access, affordability, and quality of services, as well as strengthening institutional and policy frameworks.