UN ESCAP/CDPF Field Study cum Regional Workshop on Capacity Building of Grassroots Self-help Groups of Persons with Disabilities in Local Communities - Second Phase of and Follow-up to the Regional Workshop on Poverty Alleviation of Persons with Disabilities
Chengdu, Sichuan Province, China, 16-18 August 2005

RETA 5956 Identifying Disability Issues Related to Poverty Reduction

Cambodia Country Study

Prepared by: Foundation for International Training

for: Asian Development Bank

AAR-J – Association to Aid Refugees, Japan ABC – Association of the Blind, Cambodia ADB – Asian Development Bank ADD – Action on Disability and Development AFSC – American Friends Service Committee AmCross – American Red Cross CABDIC – Capacity Building for People with a Disability in the

Page FOREWORD AND ACKNOWLEDGEMENTS

COUNTRY BRIEF

I. INTRODUCTION............................................................................................ 1

II. COUNTRY NEEDS: POVERTY PROFILE ..................................................... 2

III. REVIEW OF LEGISLATIVE AND POLICY FRAMEWORK............................. 7

IV. DISABILITY ORGANIZATIONS AND DEVELOPMENT

V. RELATIONSHIP BETWEEN DISABILITY AND POVERTY

VI. FRAMEWORK FOR PARTICIPATORY DEVELOPMENT .............................28

VII. CONCLUSION/ ANALYSIS ...........................................................................30

VIII. RECOMMENDATIONS .................................................................................32

APPENDIXES

On March 8, 2002, the Foundation for International Training (FIT) entered into a contract with the Asian Development Bank (ADB) to provide technical assistance through RETA 5956, “Identifying Disability Issues Related to Poverty Reduction.” The objectives of the Project were to:

(i) familiarize developing member countries (DMC) with the ADB’s overarching objective of poverty reduction and other related ADB policies to help address the vulnerability and poverty situation of people with disabilities;

(ii) identify and analyze the DMC’s national policies, programs, projects and initiatives concerning disabilities and poverty to be used as a basis for action plans;

(iii) provide a forum for ADB, Government and people with disability groups/organizations to identify and discuss the needs and concerns of people with disability, particularly those related to poverty; and

(iv) develop a disability checklist for the ADB.

The project was carried out in four countries: Cambodia, India, the Philippines and Sri Lanka. In each country, FIT mobilized a two-person team of multi-disciplinary specialists in disability and poverty reduction policy and participatory development. These local consultants carried out the research, documentation, and policy activities at the country level. The results of this work are documented in Country Study Reports and Recommendations prepared for each country.

The Project was led by an international team leader, Dr. Lorna Jean Edmonds. Dr. Edmonds provided invaluable guidance and direction in the structure and development of the country study reports. This Country Study Report was produced by Mr. Son Song Hak, the Project’s Disability and Poverty Policy Specialist for Cambodia. Mr. Hak was assisted by a Participatory Specialist, Mr. Sidevil Lim. Together Mr. Hak and Mr. Lim organized a series of provincial and national-level workshops; the recommendations that emerged from this process form an integral component of this Country Study. This work benefited from support and cooperation from the Ministry for Social Affairs, Labor, Vocational Training and Youth Rehabilitation. The editing of the Country Study Report and Recommendations was carried out by the team at FIT led by Ms. Michelle Sweet, Project Manager.

A. General Data

B. Demography

C. Economic Indicator

D. Health

E. Disability Statistic

F. Population Below National Poverty Line

G. Distinct Country Issues

H. Source

1. In 1999, the Asian Development Bank (ADB) adopted poverty reduction as its overaching goal. This goal is highly relevant with respect to addressing disability issues, including the prevention of the causes of disability, generation of appropriate support services and structures, the equalization of opportunities for people with disability to contribute to poverty reduction, and social and economic development. In 2001, the Social Protection Strategy was approved to address the needs of the most vulnerable, including people with disabilities.

2. The purpose of the Asian Development Bank’s (ADB) Regional Technical Assistance project “Identifying Disability Issues Related to Poverty Reduction” is to assist four selected developing member countries (DMCs), Cambodia, India, Philippines and Sri Lanka to develop country strategies and action plans, and for ADB to develop recommendation for a regional approach to mainstreaming disability issues within their programs for poverty reduction and social development. This will strengthen the capacity of the DMCs for implementation of the same.

3. In Cambodia the project obtained support from the government through the Ministry of Social Affairs, Labour, Vocational Training and Youth Rehabilitation (MOSALVY) through the provision of office space and staff involved with the project. The consultation process started at project inception in April 2002. A total of two provincial workshops were held in May and June to investigate and document the experiences and issues of people with disabilities. An assessment of the current institutional framework and stakeholders’ capacity to mainstream disability issues in the poverty reduction programme was also included in this work. The outcomes of this process were presented at the National Workshop held in July 2002. (Outcomes attached as Appendix Two)

4. Over 100 people participated in the consultation process. These groups represented 16 ministries, 28 United Nations and international agencies and NGOs, national institutions, the Disability Action Council (DAC1) and 12 representatives of people with disabilities at the national and provincial levels, who have drawn on their experiences and analysis relating to disability and rehabilitation.

5. The contribution of this report is the profiling of the major factors impacting on the life of the persons with disabilities as a result of a countrywide investigation. The participatory process used to carry out this work ensured that this Report and the Recommendations also reflect the experiences and advice of key stakeholders, particularly persons with disabilities. Collectively, this Report and the process completed have served to focus our attention on the imperative for addressing disability issues in national and ADB-led poverty reduction and growth strategies.

1 Disability Action Council acts as the National Task Force or the National Coordination body concern disability and rehabilitation.

II. COUNTRY NEEDS: POVERTY PROFILE

A. Background

6. Cambodia’s recent history of war, conflict and international isolation has contributed to its current economic status as a least developed country, and to the large number of people with disabilities, widows, and orphans. The breakdown of many basic social services and the destruction of national infrastructure, the lack of basic health and food security, and the absolute poverty of the majority of its citizens (35.9 percent of the population), have left the country with a large number of vulnerable groups. The recovery process is hampered by the developmental problems associated with extreme poverty.

7. After more than two decades of war, over ten million anti-personnel landmines and unexploded ordnances (UXO) have been left in Cambodia, which have killed and maimed thousand of children, women and men. Although mine awareness and clearance activities conducted by the Cambodian Mine Action Centre (CMAC2) and several other non-governmental organizations, hidden-weapons still continue to kill and maim Cambodians everyday. The statistics from the Cambodian Red Cross reveal that from 1979 to June 1999 an average of 200 Cambodians a month had been maimed. The injuries caused by landmines continue and approximately 60 people are injured each month. The majority of these lose at least one limb. It is also estimated that there are approximately 45,000 amputees in Cambodia, or one in 226, the highest number in the world caused by this dreadful weapon alone.

8. Cambodia is currently experiencing a new phase of peace and stability. The current government was legitimized and internationally recognized through the 1998 national elections. As a result, Cambodia has been accepted as a full member within the Association of South East Asian Nations (ASEAN), which is expected to increase opportunities for exchanges and interaction with neighbouring countries. This progress towards political stability is reflected by corresponding internal economic growth. However, despite these positive changes, Cambodia remains in a post-war recovery phase and reconstruction activities are proceeding slowly. The scale of destruction resulting from decades of catastrophic civil war is devastating, and its legacy persists in the human, civil, economic and cultural fabric of Cambodian society. Moreover, the rapid economic growth, which has resulted from the abrupt introduction of a market economy, has created a marked imbalance, widening the gap between the rich and the poor3.

9. According to the results of the General Population Census, in March 1998 Cambodia had a population of 11.43 million people with an annual growth rate of 2.49 percent. Females represent 51.8 percent of the population. There are 2.18 million households, of which 0.55 million or 25.7 percent are headed by women. The number of economically active persons is 5.1 million, of which 51.6 percent are females. Unemployment rates are higher for females: 5.9 percent against 4.7 percent for males. Urban areas record unemployment rates that are higher than those for rural areas. ⁴

10. Over 84 percent of Cambodians are based in rural areas, where 3,400,000 people (40 percent of the population) live below the poverty line. Of the 15 percent of the population living in urban areas, 24 percent or an additional 360,000 live below the poverty line. In 1994, the First

2 Cambodian Mine Action Center

B. Socio-economic Situation of People with Disabilities

1. Statistical Information

11. The Cambodia Socio-Economic Survey 1999 by the Ministry of Planning shows that illness and diseases had been the principal cause of disabilities in Cambodia. Congenital disability is reported as the second most important cause of disability in the country. Landmine explosions were the cause of disability of 10.8 percent of the population of Cambodia. The cause of disability of more than one out of 10 in the country as a whole is reported as war or conflict. More than three times as many males as females have been disabled by the combined causes of landmines war and conflict.

12. A number of assessments of the situation of people with disability in Cambodia have been carried out, but they were mostly confined to issues related to the planning needs of the specific organizations that conducted the studies. Many of these assessments, including those carried out by MOSALVY have based their findings on the 1998 census, which indicated that of the total population of 11,300,000 in Cambodia, 220,000 are physically disabled. This does not include persons with intellectual disability.

13. The ADB’s “Study on Skills Training as a National Strategy for Poverty Reduction in Cambodia” reported that by conservative estimates, approximately 9.8 percent of the people of Cambodia have significant physical or intellectual disabilities that limit their abilities to function independently on a daily basis. This grim statistic means that Cambodia has one of the highest rates of people with disabilities, on a per capita basis, in the world. The breakdown of essential services and the presence of landmines are the legacies of more than 20 years of conflict in the country and the causes of the continuing high incidence of disabling conditions.

Cambodia has an extremely high proportion of people with disabilities. Out of approximately 10,200,000 people, there are 100,000 whose mobility is impaired. Of this number, roughly 40,000 are amputees and 60,000 have been disabled as a result of polio. There are also an additional 100,000 blind Cambodians and an estimated 120,000 who are deaf. This makes a total of 320,000 Cambodian who have a serious physical disability and represents 3 percent of the population.

Using the international average to make a rough estimate based on Cambodia’s population of 10,200,000, this means that there would be between 204,000 to 257,000 children with intellectual disabilities, 20,400 to 40,800 people suffering form severe mental illness, 153,000 to 408,000 people with epilepsy, and 306,000 to 530,000 people who have significant personality disorders. Taken as a whole this means that in Cambodia at a minimum there are 1,003,400 or 9.8 percent of the population who have significant physical or mental disability which affects their ability to function independently on a daily basis. Both physical and mental disabilities carry a stigma as they are considered to be a punishment of the past sins. Cambodians with disabilities are amongst the poorest in any community unless they have a family that is both willing and able to support them6.

5 Interim Poverty Reduction Strategy Paper, Royal Government, 2001

14. Based on the most recent finding, a survey in Cambodia made by United Nations and Disabled Persons7 estimated that people with disabilities comprise about 1.4 million or 15 percent of the total population of Cambodia.

15. However, it should be noted that all figures8 provided for disability are estimates. To date there has been no single satisfactory study that provides an accurate figure for the number of people with disabilities in Cambodia, and a variety of different studies have provided these different figures. This is in part due to the inadequate registration of people with disabilities and all figures should therefore be viewed with caution.

2. General Situation

16. Persons with disability are perceived in Cambodian culture and Buddhist religion as social handicaps. The loss of physical or mental capability is regarded in relation to the individual's destiny, and may be considered to be the result of faults accumulated in previous lives. This often results in a sense of guilt and social stigma that increases the exclusion experienced by most persons with disabilities. People with disabilities are marginalized within Cambodia and are often excluded from community development by their own communities. Although there are many NGOs working in the disability sector most are focused on rehabilitation, but do not assist people with disabilities to identify the main causes of their situation, and encourage them to find their own solutions. A sense of hopelessness, loneliness and a lack of affection from families, relatives and friends, compounded by isolation are common problems among persons with disabilities in Cambodia. Even those with the capacity and skills to enter mainstream society are generally not provided the opportunities to do so and often resort to begging, and/or become alcoholics and engage in anti-social behavior.

17. People with disabilities are one of the most vulnerable and poorest groups in Cambodian society. People with disability are generally the poorest among the poor with very limited access to basic social services, education, skills or vocational training, job placement, and income generation opportunities, thus exacerbating their poverty. Many organizations view disability as a condition of occupational disadvantage that can and should be overcome through a variety of policy measures, regulations, programmes, and services. ⁹

18. Disability legislation is the top priority of the disability sector in Cambodia. Legislation is crucial to promote the full participation and equality of persons with disabilities. Rights-Based Legislation emerges from the recognition that people with disabilities have the same rights as persons without disability. Therefore, the law must protect the basic rights of persons with disability for a life with dignity (ESCAP: Legislation in Equal Opportunities and Full Participation in Development for Disabled Persons, 1995).

19. The need to remove social stigma to allow the full reintegration of people with disabilities into Cambodian society is a long-term issue, which will require a coordinated and global approach. The approach must not only aim to remove the causes leading to disability, but must also strengthen training and work opportunities for persons with disabilities and increase their social rights, acceptance and dignity. Reintegration must involve empowerment of people with disability so that they may fulfil their own potential and contribute to the rebuilding of their

7 United Nations and Disabled Persons, Bangkok, 1999.

20. One key factor in the reintegration of people with disabilities is education. Education is a human right and a basic need. In Cambodia, however, education in general has suffered greatly from political, social and economic turmoil. The Khmer Rouge Regime was responsible for the almost complete destruction of the education system. Efforts over the past two decades have focused on emergency relief--opening schools and the training and deployment of teachers. It was only towards the end of the last decade that the transition from emergency relief to reconstruction and development began.

21. Education for all persons in Cambodia is imperative. For people with disabilities formal and non-formal education are among the most essential services for child survival and development; education is also a vital means of empowerment and self-help. As a signatory to the UN Convention on the Rights of the Child the Royal Government of Cambodia has a legal obligation to provide education opportunities for children with disabilities. The Ministry of Education, Youth and Sports has made a policy commitment to attain Education for All by 2010. This commitment implicitly covers children with disabilities.

22. It is recognized that education is critical for all persons in Cambodia. The current situation of limited capacity and inadequate resources in the general education system, particularly in rural areas, has resulted in many children being excluded from education altogether, resulting in a high illiteracy rate and low skills. This is particularly the case among children with disabilities who are the most vulnerable to exclusion. This situation has contributed to a further reduction in employment opportunities for people with disabilities.

23. Cambodian schools and teachers are not equipped to teach children with disabilities. Therefore disabled children are often kept away from school by their parents or are told by their teachers not to attend and their future becomes doubly limited. Their sense of self-confidence and subsequent ability to access services that do exist for them once they become adults will also be limited. This is particularly critical in terms of non-formal vocational and skills training programs, as people with disability with little or no education do not have ready access to the very programs and services designed to help them overcome these problems. It also leaves them dependent on the good will of their relatives and village leaders or on the proactive efforts of community rehabilitation and other development workers to locate them and to find out if they are interested in or able to take advantage of skills training programmes. ¹⁰

24. To date, programmes to promote education for people with disabilities have been limited to those implemented by NGOs and agencies focusing on children with disabilities. A very limited number of special schools and classes exist, as do some community-based initiatives. Collectively these services only provide education for a very small minority of disabled children and are concentrated mainly in urban areas. The programmes provide almost exclusively for children with physical disabilities and sensory impairments. A very small number of children with disabilities are included into the mainstream education system, as the present school environment does not facilitate their integration.

10 Dana Peebles, Women and Vulnerable Groups Strategy Planner, 1997.

Children with Disabilities have the right to "an education that develops his or her personality, talents, mental and physical abilities to the fullest" UN Convention on the Rights of the Child

25. A major factor restricting the full participation and equality of people with disabilities is the prevalence of perceptions and practices that prevent them from functioning as full members of society. Often the abilities of people with disabilities are not recognized. They face social and economic marginalization, discrimination, and have very limited access to resources. Therefore, they find their opportunities for full and equal participation limited. Public awareness, outreach and mass education campaigns, as well as efforts to mobilize the private sector and communities to support the eradication of discrimination, are almost non-existent.

26. Skills training, income generation and job placement are important factors in the rehabilitation of people with disabilities. In Cambodia people with disabilities typically come from the poorest segments of society. For these persons with disability the ability to secure income for themselves and their families is their highest priority. Income generation for persons with disabilities not only contributes a sense of dignity and self-confidence, but is directly linked to poverty reduction and social development.

27. Cambodia’s built environment contains many obstacles for people with disabilities. The majority of public buildings have inaccessible entrances and exits. Toilets are usually located upstairs in small cubicles and never have supporting handles. Some of the larger hotels have accessibility features such as lifts, wide doors and corridors. However most smaller hotels and guesthouses are inaccessible. Problems are similar in hospitals and schools. Higher-level institutions typically have several flights of stairs. Features that should be accessible include entrances, exits, door handles, handle rails, floor surfaces, corridors, toilets, escape routes, elevators, and staircases. External environment barriers include obstructions on footpaths, uneven or no footpaths, street vendors and cars on footpaths, no kerbed ramps, steps, etc.

28. Awareness of accessibility for people with disabilities is minimal outside of organizations working on the promotion of the rights of people with disabilities. However, some adaptations to the built environment and the external environment can be achieved at a minimal cost with creative thinking and careful consideration given to people’s needs. People with disabilities experience difficulties in moving around the numerous obstacles of the built environment on a daily basis. Therefore, people with disabilities and organizations representing them should be consulted from the early planning stages.

29. The prevalence of preventable diseases is often linked to poverty. Poor living conditions, economic situation, family size, the caregiver being the income earner and seasonal shortages of food compound access to health services. Often a lack of money and education prevents people from making decisions to avoid or manage their health problems. Women in some parts of the region have little or no access to basic medical care during pregnancy, childbirth and post delivery. This can lead to risks for mother and child, possible complications and disease and disability. It is estimated that worldwide 10 percent of children are born with or acquire a disability. Children in Cambodia are at risk of disabilities preventable by vaccination, such as measles, neo-natal tetanus and poliomyelitis. Malnutrition is widespread, often resulting in Vitamin A deficiencies, iodine deficiencies, and other nutrient/protein deficiencies. For some the problems of malnutrition begin before birth thus disadvantaging people early on in life. Tuberculosis too is a public health concern, with Cambodia having one of the highest transmission rates in the world, in addition to HIV/AIDs and malaria.

31. Cambodia became a signatory to the Convention on the Prohibition of the Use, Stockpiling, Production and Transfer of Anti-Personnel Mines and on their Destruction, also known as the Mine Ban Treaty, in Canada on 3 December 1997.

Cambodia Poverty Profile for 1999

III. REVIEW OF LEGISLATIVE AND POLICY FRAMEWORK

A. Disability Legislation

32. At present, Cambodia has no legislation on disability. Based on recommendations of the Task Force, May 1996, the DAC Legislation Working Group, comprised of representatives from various NGOs and MOSALVY and led by the Cambodian Disabled People’s Organization (CDPO), was established to develop a draft law.

33. Following the working draft in the year 2000, a Consultative Working Group was formed with the representatives of ministries, organizations of people with disability, and people with disabilities. It was then suggested to form an Expert Working Group for redrafting the legislation in keeping with the process of legislation development in Cambodia. The draft was completed and put forward to MOSALVY as the responsible Ministry in July 2000 for further consideration and action before submission to the Council of Ministers. The National Assembly and Senate will adopt the draft legislation. The law will give MOSALVY and the DAC the responsibility for disability action planning, management of people with disabilities, provision of services for people with disabilities, rehabilitation and employment, and monitoring and inspections in coordination and consultation with other involved ministries and organizations. The draft legislation also calls for preparation of sectoral management plans by various ministries in co-operation with MOSALVY and the DAC.

34. A new Working Group is established under the official letter of MOSALVY comprised of four members from MOSALVY, including two senior staff; an Advisor to the Minister; one representative from CDPO; and one from DAC. A Cambodian legal expert was recruited to provide legal and technical guidance during the process. The Working Group was given a mandate to review and revise the draft as well as to follow up with the process until the legislation is discussed and adopted by the National Assembly and the Senate. The work at the Ministry level was completed during the first week of May 2002, and the Group hopes to submit a final draft to the Council of Ministers before the end of 2002. The Legislation is comprehensive, covering specific areas such as quality of life, rehabilitation, health and the prevention of disabilities, accessibility, education, training and employment, incentive programs, elections, etc. (Draft of the legislation is attached as Appendix One).

35. The draft law is designed to provide a set of practical approaches to deal with some of the numerous problems facing persons with disabilities in Cambodia. Many other provisions could have been included and some provisions could be strengthened. However, given the very limited human and financial resources of the Government, the proposed draft law aims to be practical and workable. The law will be a first step in a long-term process of developing a law that fits the current situation in the country.

B. National Policy

1. Mandate of the Government

36. The Constitution of the Kingdom of Cambodia states that “every Khmer citizen shall be equal before the law, enjoying the same rights, freedom and fulfilling the same obligations regardless of race, color, sex, language, religious belief, political tendency, birth origin, social status, wealth and other status”. (Section of Article 31 of the Constitution)

2. Formal Obligations of the Government

37. The Government of the Kingdom of Cambodia signed and recognized the following treaties, conventions and declarations. They relate either directly or indirectly to the rights of people with disability.

• UN Universal Declaration of Human Rights

3. Moral Obligations of the Government

39. The year 1981 was declared the International Year of Disabled Persons by the United Nations. At the end of that year the UN adopted the World Programme of Action Concerning Disabled Persons (UN General Assembly, 37th Session, 1982, Resolution 37/52) during the UN Decade of Disabled Persons (1983 – 1992). The World Programme of Action aimed at the promotion of effective measures for the prevention of disability, rehabilitation and the realization of equal opportunities for persons with disabilities11.

40. The United Nations facilitated the drafting of the Standard Rules on the Equalization of Opportunities for Persons with Disabilities, which were adopted by the UN General Assembly in December 1993 (48th Session, 1993, Resolution 48/96). The Standard Rules constitute a set of objectives implying a strong political and moral commitment by the State to take action for the equalization of opportunities for persons with disabilities. They also propose the establishment of a mechanism for the close collaboration between the State and organs of the UN, NGOs, and Disabled Persons Organizations.

41. Other moral obligations for State, which partly concern the rights and responsibilities of persons with disability, can be found in the UN Convention on the Elimination of All Forms of Discrimination against Women and the UNESCO World Declaration on Education for All.

42. The Ministry of Social Affairs, Labor and Veterans Affairs (MSALVA), the present MOSALVY has been mandated by the Royal Government to lead and manage social affairs, labor, vocational training, and youth rehabilitation in Cambodia. One of the main tasks of MOSALVY is to prepare guidelines and regulations for the protection and the welfares of Cambodian persons with disability. It also coordinates rehabilitation services for all categories of persons with disability.

43. In 1995, MSALVA initiated a joint ministry-NGO process to develop a National Strategy for the continuation, development and coordination of appropriate programmes and services in the sector. The initiative was called the National Task Force on Disability. A crucial step for the Task Force was the development of fourteen “Guiding Principles” as overall guides for developing a national strategy for the sector. The Task Force determined that adherence to these basic principles would help ensure coordination and forward movement with the sector, and prevent overlap and conflicting programmes that might otherwise develop from 53 separate agencies working with a common target groups.

11 Disability Action Council, Strategic Directions for Disability and Rehabilitation Sector in Cambodia, Feb, 2001.

C. Country Poverty Reduction Strategy

44. Reducing poverty in Cambodia is the primary development objective of the Government of Cambodia, as poverty is economically wasteful, morally unacceptable and socially divisive. The Royal Government of Cambodia has declared its commitment to making a concerted and sustained national effort to poverty reduction so that all Cambodians, including vulnerable groups, can reap the benefits of economic growth and participate in the development process. Rapid poverty reduction is seen as an integral part of the process of national reconciliation and cultural renewal and key to the maintenance of political and social stability.

45. The government recognizes that faster economic growth alone may not be enough to significantly reduce poverty in Cambodia because of the large and growing inequalities associated with observed growth patterns. The poor of Cambodia include many people who are at risk of being left behind as the economy grows. This includes persons with disabilities, the aged, the landless and the unemployed, as well as subsistence farmers and particular groups among the urban poor. Gender biases and illiteracy increase the likelihood that many of the poor will be unable to participate in economic growth. As poverty reduction in Cambodia depends on the nature of the growth path and what types of incomes are raised, the ability of economic growth to create jobs, particularly for the disadvantaged, is of critical importance. It is equally important to continue programmes aimed at providing direct support and protection for the poor such as the World Food Program’s (WFP) Food for Work projects and the government’s emergency food targeting schemes.

46. At a National Workshop, held in May 2000 to launch the preparation of the Second Socio-Economic Development Plan 2001-2005, Prime Minister Samdech Hun Sen stated that the Royal Government’s main poverty reduction strategy is geared to achieving (i) Long-term, sustainable economic growth at an annual rate of 6 to 7 percent; (ii) Equitable distribution of the fruits of economic growth between the have and the have-nots, between urban and rural areas and between the two opposite sexes; and (iii) Ensuring sustainable management and utilization of environment and natural resources. The Government’s strategic motto is “Poverty reduction through high economic growth over the long term by ensuring environmental sustainability and social equity”. ¹²

47. The Royal Government’s Political Platform for the Second Term 1998-2003, presented by Prime Minister Hen Sen in November 1998 to the National Assembly, spelled out the parameters of domestic, defense, foreign, economic and social policies. The principal guidelines of the social policy is to strengthen the country’s capacity in terms of human resource development, improving the health status of the population and widening access to economic opportunities for poor and vulnerable groups including people with disabilities, orphans, widows, women in crisis and homeless people.

48. The objectives of the government’s economic policy are to promote sustainable development, maintain macroeconomic stability and foster durable management of natural resources. The economic platform sets the following four main goals:

• accelerate economic growth to improve the living standards and create employment for the population;

12 Royal Government of Cambodia, Interim Poverty Reduction Strategy Paper, Oct. 2000.

• reduce poverty of the population.

49. The Government’s economic reform program is geared to ensure macroeconomic stability, strengthen the banking and financial system, undertake fiscal reform measures, establish a sound management of public property and increase public investment in the area of physical and social infrastructure, promote private sector development, and develop human resources. The government’s economic objectives are centered on poverty alleviation and sustainable economic growth and are clearly stated in the Policy Framework Paper (PFP) prepared in October 1999. The key elements of the strategy are:

• strengthening revenue collections and enhancing the transparency of fiscal operations, combined with reforms of the civil service and military;

50. A comprehensive National Strategic Direction for Disability and Rehabilitation Sector has been developed by Disability Action Council (DAC) in February 2001 as a result of several discussions during meetings and workshops by the specialized and technical committees as well as the Government Departments concerned with disabilities. The document has been developed based on the following principles14:

• Constitution of the Kingdom of Cambodia

51. It is important to note that this strategic direction has not been recognized by the government. DAC continues to seek this recognition.

52. MOSALVY has indicated that, for the foreseeable future, the strategic approach of the Cambodian government regarding disability issues will be as follows:

1. Government Role

• Consultation with institutional stakeholders and coordination agencies;

13 Royal Government of Cambodia, Interim Poverty Reduction Strategy Paper, Oct. 2000. 14 Disability Action Council, Strategic Directions for Disability and Rehabilitation Sector in Cambodia, Feb, 2001.

2. Third sector (NGO) role

• Consultation with institutional stakeholders and coordination agencies;

3. The Minister stresses that this approach is informed and driven by:

• An evolving government policy preference that service delivery should be provided by the third sector as a matter of principle; and

• Ongoing, pragmatic and financial realities that make it impossible to secure adequate, government funded service delivery without the fullest possible participation of the third sector, and the increasing realization that the government may never be in a position to provide all the services that are required under UN-ESCAP.

D. National Coordination (National Task Force)

53. The Disability Action Council (DAC) was created in late 1997 to replace the National Task Force on Disability as a permanent National Coordination Body to coordinate, initiate and secure services necessary for people with disabilities to enjoy equal rights and obligations as well as opportunities and quality of life as others in the community.

54. The DAC is a national coordination body made up of representatives from the government, the disability and rehabilitation sector, national and international organizations as well as organizations of persons with disability. Currently the Government is represented through the Ministry of Social Affairs, Labor, Vocational Training and Youth Rehabilitation, the Ministry of Education, Youth and Sports and the Ministry of Health.

55. The DAC has the mandate, the neutrality and the representation of all key participants in the field of disability and rehabilitation that is required to effectively and efficiently undertake this vitally important co-coordinating role. The DAC acts in a professional advisory capacity in relation to government and policy-makers on all issues affecting the well being of people with disabilities. It also serves as a national focal point on disability matters to facilitate the continuous evolution of a comprehensive national approach to rehabilitation, equalization of opportunities and prevention of disabilities.

• DAC's Vision: Individuals and society recognize that persons with disabilities (PWDs) have equal rights and obligations as citizens of the Kingdom of Cambodia. PWDs are given equitable opportunities to participate in society, based on their abilities, enabling them to lead a life free of discrimination.

IV. DISABILITY ORGANIZATIONS AND DEVELOPMENT AGENCIES

A. Role of the Sector in Poverty Reduction

57. Mainstreaming disabilities issues can be a key and cost-effective element in reducing poverty. Therefore the disability and rehabilitation sector plays the most important role in promoting multi-sectoral collaboration for mainstreaming of people with disabilities in all activities in society. Promoting equal opportunities includes the following elements: legislation and policy; attitudinal changes and public awareness initiatives; access to rehabilitation services and assistive devices; promoting barrier free environments; education, training and employment; national co-ordination; and self-help organizations of people with disabilities and supporting government ministries and NGOs. Effective enforcement and implementation of these components will contribute to addressing the needs of people with disabilities.

B. Review of Existing Programmes

58. There are a considerable number of organizations providing services for persons with disabilities that cover most of the 12 areas set out in the World Programme of Action Concerning Disabled Persons16. However, geographical coverage as well as the types of disabilities addressed remains limited. In the absence of policy guidelines and long-term investment plans for the sector, the Government of the Kingdom of Cambodia has so far had a modest role in the development of programmes. Furthermore, disability issues remain restricted to the Ministry of Social Affairs, thus neglecting the multi-sectoral nature of disability concerns. Below are the list of programmes and providers given by Strategic Direction on Disability and Rehabilitation, DAC.

1. Information and Database

59. Most organizations providing services to persons with disabilities collect their own data. This data collection mainly serves the needs of specific projects covering particular types of disabilities, services and geographical areas. Therefore, the different databases do not provide information that can be easily compared. In addition, information on certain types of disabilities is altogether missing, such as information on intellectually persons with disability. Recently,

15 Disability Action Council, Strategic Directions for Disability and Rehabilitation Sector in Cambodia, February,

efforts have started to improve the co-ordination of data collection and to make databases compatible17.

60. The “Socio-Economic and Behavioral Pilot Survey on the Situation of Disabled Persons in Cambodia” included efforts to establish a disability database independent of a specific service or project. The first phase of the study was carried out in 1999 in the provinces of Bateneay Meanchey and Kampong Spue, with a second phase in 2002 in Kampong Spue. This study was coordinated by the DAC Secretariat in collaboration with the DAC’s Disability Data Base Steering Committee and the MOSALVY with support from UNICEF.

61. While information and databases on disability remain insufficiently developed in Cambodia, two types of databases are available at DAC. Firstly, demographic databases contain information on the types and prevalence of disabilities as well as on the socio-economic situation of persons with disabilities. The second type collects information on services available to persons with disabilities and matches the needs of persons with disabilities with these services. Efforts are being made to expand both types of databases as well as to establish new databases.

2. Disability Public Awareness

62. Based on the last survey of disability awareness activity made by DAC, there are nine organizations among 53 organizations surveyed that have been carrying out disability awareness activities, one among them the Cambodian Disabled People’s Organization, which is now suspended most of its activities. The survey assumed that the operational capacity of these organizations is still limited due to the reports, observations, and direct interviews. Many organizations working in the disability sector integrate awareness activities in their programmes by helping their staff, community members, and people with disabilities and their families gain confidence and awareness of rights, abilities and opportunities of people with disabilities in society. Yet these activities are not well coordinated, systematic, or nation wide in their geographic coverage. These activities are also constrained by a lack of human and material resources and a developed capacity to apply appropriate methodologies, design and implement activities and use the media effectively.

3. Accessibility and Communication

63. It has been recognized that Cambodia’s built environment contains many obstacles for people with disabilities; the majority of public buildings have inaccessible entrances and exits. There has been lack of knowledge on accessibility among builders, decision makers and funding bodies. DAC’s Children with Disability sub-committee and CDPO have sought to build greater understanding of accessibility issues through limited media and public awareness campaigns. However, this work has been challenged by a shortage of resources and its real impact on attitudes in not clear.

64. There are gaps in the area of communication in Cambodia, but many organizations are looking to expand their services for visually and hearing impaired persons. There is a general lack of availability of assistive devices and tools, i.e. hearing aids, Braille machines, speech therapists, etc. Also, there is no certification of sign language interpreters in Cambodia. Khmer Sign Language is under development by technical deaf people from Cambodian Disabled

17 Disability Action Council, Strategic Directions for Disability and Rehabilitation Sector in Cambodia, February,

4. Education

65. To date education programmes for people with disabilities have been implemented solely by non-governmental organizations and focus on children with disabilities. A limited number of special schools and classes exist, as do a few community-based initiatives. Collectively their services meet the needs of only a fraction of children with disabilities in Cambodia, less than one percent. These programmes are concentrated mainly in Phnom Penh and other urban areas and currently cater almost exclusively for children with physical disabilities and sensory impairments. All the special schools have integration in the mainstream as their ultimate goal.

66. Ministry of Education, Youth and Sports (MoEYS) has established a Special Education Office, located within the Primary and Pre-school Department. This Special Education Office has responsibility for developing education opportunities for children with disabilities, girls, minorities, and other vulnerable groups such as street children. However, clear terms of reference and the roles and responsibilities of this Special Education Office have not yet been defined.

67. Through a joint effort of the DAC, MoEYs, UNICEF and NGOs, an initiative to build a model for Inclusive Education has been underway in Svay Rieng province since the year 2000. Although this model is currently being developed only on a limited scale, it provides hope for the future. The model has now been adopted by MoEYS in five other provinces. However, a nonquantifiable number of children with disabilities are intrinsically included into the mainstream education system. A recent small-scale survey conducted by the Disability Action Council in one school cluster in Svay Rieng revealed that there were between 8-10 children with disabilities in each primary school. Evidence from other NGOs working in disability suggests that for children with mild and moderate physical disabilities integration presents few difficulties. Poverty is the main barrier. Parents who lack the resources to send all their children to school prioritize education for their able-bodied children. Paradoxically it seems that in rural areas more children with disabilities are attending local schools. This suggests that negative attitudes are stronger in urban areas than in rural areas. However the vast majority of children with disabilities are currently excluded from education and for those in mainstream schools it is difficult to assess the quality of education and the experience they are having. They may be physically present at school but not fully included into the school life.

5. Training and Employment/Micro-enterprises

68. Skills training, income generation and job placement is an important factor in the rehabilitation of persons with disability. In Cambodia people with disabilities typically come from the poor and poorest segments. Income generation for persons with disabilities not only contributes to establishing a sense of dignity, self-confidence and respect among persons with disabilities, but also is directly linked to poverty reduction and development.

69. According to the National Strategic Direction, there are currently 16 Local and International NGOs working in collaboration with MOSALVY to implement programs of vocational skills training, employment and income-generation for persons with disability in Cambodia (See Annex A for more information of organizations and activities).

70. However, the range of employment after graduation is limited. At this moment most training courses assume that the graduates will become self-employed. This is an option for some, but not for all graduates. All skills training programmes are intended to assist the extrainees develop their own businesses. This is an appropriate strategy given the large percentage of the population living in rural areas. However, training needs of people with disability vary depending upon the particular circumstances which make them vulnerable, their age and the number of dependents they have. For example those who are most marginalized are often unable to attend lengthy skills training programmes as they cannot afford the loss of income this entails. They also need additional support following the skills training program in the development of business management skills and access to affordable credit. Follow-up models that have proven to be effective for these groups, including the setting up of short-term apprenticeships and peer support groups, are to be strengthened.

71. In 1998 the National Centre for Disabled Persons, based in Phnom Penh, established an information network for referral services for people with disabilities who are looking for employment in Phnom Penh, Kampong Spue and Kandal provinces. To date 1900 people with disabilities have been registered, among whom only 258 persons, or 13 percent of the total registered, have obtained employment in Phnom Penh. ¹⁸

72. Currently, mainstream programmes are not serving people with disabilities in any significant numbers. This is the argument used by NGOs in favor of supporting specific programs for persons with disability.

6. Prevention of Causes of Disabilities and Medical Rehabilitation

73. As Cambodia has recently emerged from the prolonged war and conflict, the lack of basic health care, malnutrition, bad hygiene, landmines, battles, and poverty have been regarded as serious causes of disabilities in Cambodia. On the other hand, it is reported that disabilities caused by traffic accidents are increasing, especially in Phnom Penh, due to the rapid and uncontrolled increase of the number of vehicles/cars and motorcycles and weak enforcement of traffic laws. The compulsory use of seat belt in vehicles and helmets for motorcycles has not been enforced.

74. The result of cooperation between the Government of Cambodia and many International NGOs and Organizations is a greater commitment to improve the health and well being of all Cambodian people, by:

• giving special attention to health education, preventive and curative health care in rural areas;

18 National Center for Disabled People May 2002.

• enabling affordable access to medical services.

75. Efforts to prevent landmines injuries focus on mine awareness programmes, as international lobbying for complete ban on the stock piling, production, transfer and export of mines continue to meet with stiff resistance from some countries. Community members have to be told about the prevalence of mines in their areas, their location (if available) and ways to avoid them. They have to be told of the proper way of managing the injured so that preventable amputations can be avoided. The Cambodian Mine Action Center (CMAC) is working on developing a National Demining Plan for long term planning of demining activities, and better collaboration and coordination.

76. The World Health Organization (WHO) and other international health sector organizations acknowledge that there will be an ever-increasing number of persons with disabilities in the world. This is due to many factors that vary from country to country. In Cambodia there will continue to be injuries caused by the legacies of war (mines and UXO), limited and affordable health services, and those resulting from chronic illnesses and increasing violence and traffic accidents. Physical Medicine and Rehabilitation is especially related to the Prevention of Secondary Disability as explained below.

77. The aim of all countries is to prevent disabilities. This generally takes the form of the following:

• Prevention of Primary Disability: improving health services and conditions e.g. vaccinations, Vitamin A supplements, adequate pre-natal care plus policies and programmes aimed at reducing the incidence of mine victims, accidents and domestic violence.

• Prevention of Secondary Disability: intervention is needed to prevent impairment from becoming a severe disability. This can take the form of applying appropriate surgical procedures and then follow-up rehabilitation (physiotherapy, Prosthetic and Orthotic (P&O) and allied services). Mine victims require certain rehabilitation programmes while children with polio require other specific rehabilitation programmes as do those suffering from blindness, deafness, psychological trauma and other specific types of illnesses or accidents.

78. Globally there has been a shift in attitude of professionals who have been educated in and focused on the “medical” aspect of disability towards a more “holistic” approach to rehabilitation, which also encompasses “social” rehabilitation. This recognizes that a person with a disability also has social and economic needs to enable the individual to function to his/her maximum capacity in society. This requires skilled health care and social service professionals.

79. Often health professionals, such as medical doctors (including surgeons), nurses, physiotherapists and other allied health professionals do not receive adequate training in disability and rehabilitation. In addition most of the training is focused on hospitals and large institutions. Therefore it is felt that more appropriate training should be included in the training of health professionals and community workers in all countries including Cambodia.

80. In addition, it is recognized that to provide comprehensive rehabilitation services close links between hospital-based services, rehabilitation centers and services within the community must be established. Therefore in Cambodia it is felt that the following aspects need to be strengthened:

• Early identification and treatment of disease, illness and trauma thus minimizing the degree of disability;

81. The DAC has initiated the formation of a Specialized Committee whose tasks include the development of Physical Medicine and Rehabilitation in Cambodia. This will be a collaborative effort between many key players including the Ministry of Health (MOH), MOSALVY, MoEYS, WHO, relevant NGOs, international organizations and the DAC. An initial Working Group has developed a draft Terms of Reference.

82. The Ministry of Health is also developing training for primary health care service providers, primary health care package for operational districts (PHC packages) and a Minimum Packages of Activities (MPA) for preventative, promotional, curative medicine.

83. Polio related paralysis could be prevented by adequate immunization coverage of all children under five. WHO and MOH are working hard on the program to attempt to reach out to all children under five. In their last National Immunization Day, coverage was close to 100 percent. If this achievement continues, then it is predicted that in five years times, polio will be eradicated from Cambodia. This would help prevent 0.2 percent of all disabilities attributable to polio. ¹⁹

7. Rehabilitation

84. The MOSALVY has primary responsibility for programmes and services affecting persons with disabilities. The Ministry of Health (MoH) and the Ministry of Education, Youth and Sports (MoEYS), also administer programmes and services with significant impacts on persons with disabilities. Given the severe limitation of financial and human resources, the government is in no position to provide the kinds of services and programmes needed by this large population of persons with disabilities.

85. Recent extensive research on the problems of disability and persons with disabilities in Cambodia has revealed enormous gaps in the provision of services to people with disability. However, there are achievements in many fields, mainly due to the assistance of international organizations. There are over 50 organizations providing support in some form to people with disabilities in Cambodia.

86. Physical Rehabilitation/Assistive Devices. Since the beginning of P&O services in Cambodia, services providers meet regularly to discuss technical issues. From these discussions, the production of prosthetic and orthotic devices has become standardized (using Polypropylene Technology) as well as the training of prosthetist/orthotists. In 1997, the physical rehabilitation providers organized themselves in the DAC Physical Rehabilitation Committee, which aims at ensuring maximum equitable distribution of quality physical rehabilitation services to all physically persons with disability in Cambodian society. From this committee, three subcommittees exist in the areas of P&O, Wheelchairs and Physical Therapy to address the technical aspect of their fields.

19 Disability Action Council, Strategic Directions for Disability and Rehabilitation Sector in Cambodia, February,

88. The production and provision of assistive devices to persons with disabilities has been developed in some key areas of Cambodia and now covers wide parts of the country. The organizations providing these services are actively engaged in training local technicians. The main organizations that produce assistive devices and prosthesis in Cambodia are ICRC, Cambodia Trust, Handicap International, AmCross and VI; and AAR-Japan which produces only wheelchairs. It should be noted that in Cambodia there are 16 rehabilitation centers, including three based in Phnom Penh and thirteen in the provinces. Also concerning the range of devices, there is production of all kinds prosthesis and orthosis in Cambodia.

89. NGOs and their expatriate personnel have so far driven the physical rehabilitation sector. A future target and challenge will be to replace the expatriates with Cambodians while maintaining or improving the quality of services.

90. The future role of the Ministry of Social Affairs, Labor, Vocational Training and Youth Rehabilitation in the physical rehabilitation of disabled Cambodians will be a crucial factor in achieving sustainability of services. Presently the Ministry provides a considerable number of its own staff to NGO's. However, the Ministry has no operational budget, which leaves services completely financed by foreign assistance.

91. Community-Based Work with People with Disabilities/Community-Based Rehabilitation. Community-based work with people with disabilities is increasingly recognized throughout the developing world as the most appropriate and sustainable approach for the equalization of opportunities and inclusion of people with disabilities in the development of their country. Its essence is decentralized responsibility of all resources (human, material, financial) to community-level organizations and action. It is a part of wider community development. Traditionally families, communities, and society have segregated people with disabilities. This has also been the model for their ‘rehabilitation’ or ‘special care’ in most parts of the world.

92. Programmes focusing on Community-Based Work with People with Disabilities (CWD) have started in several provinces. CWD aims to address the needs of persons with disabilities and their families in their communities. These programmes provide counseling to the people with disabilities and their families where they live. They refer cases that require specialized rehabilitation to the appropriate service providers. Taking into account that for many persons with disabilities it is a priority to earn some income, CWD assists persons with disabilities to gain access to skill training and facilitates access to credit. A CWD program aims at strengthening the involvement of the community in the care of people with disabilities and advocates for better treatment of people with disabilities.

93. In Cambodia this has been the chosen approach of most of the agencies working with people with disabilities. Some agencies work with specific groups, such as those with a particular disability, or disabled children. Others include all age groups and disabilities. Despite the heterogeneity of the agencies, certain aspects of their work are agreed within the sector to be fundamental to community work with people with disabilities. These core common elements are:

• raising awareness on disability issues at individual, family, and community level;

94. The term Community Work with Disabled People (CWD) was chosen by representatives from the sector to describe this type of approach in a simple and unambiguous way. It embraces the term Community-Based Rehabilitation, and avoids the conceptual difficulties surrounding CBR. Furthermore, CWD excludes the word ‘rehabilitation’ which suggests a more technically oriented concept of work with people with disabilities. This would not accurately reflect the capacity building of most of the work in this sector.

95. CWD staff and programmes face particular constraints of accessibility. In the past widespread coverage has been impossible due to political instability. This is improving, but certain problems remain:

• security – landmines, robberies, kidnapping, insufficient staff to travel in pairs;

8. Self-help Organization of People with Disabilities

96. A self-help organization is an organization run by and for persons with disabilities, composed of people who come together voluntarily to work jointly for personal, social and/or economic development.

97. In Cambodia, a distinction needs to be made between those organizations, although few, which are themselves Self Help Organizations, and those which, as a part of their programme, have developed self help initiatives that may or may not become Self Help Organizations.

98. A national level and cross-disability membership, self-help organization in Cambodia is the Cambodian Disabled People’s Organization (CDPO), which has been recognized by the government and as one of the key player in the Disability Action Council. CDPO is an organization of people with disabilities whose purpose is to develop networks of people with disability so as to support, protect, serve and promote their rights, achievements and interests, in order to bring about their fuller participation and equality in society. The organization acts in

99. Along with its advocacy work and promoting disability public awareness, CDPO had developed a number of projects, such as the Sign Language Programme for the deaf and a Blind Musical Band, and community work with people with disability in 3 provinces dealing with the development of the grassroots movement of people with disability at the community level (self-help group). It has also played a major role in the development of sports activities for people with disabilities and facilitated in the establishment of the National Paralympic Committee of Cambodia (NPCC) 1997. In addition, CDPO is supporting a group of women with disabilities in an attempt to address their special needs and issues.

100. However, since the beginning of 2002, CDPO has suspended most of its activities due to changing directions in response to the needs of donors, clients and the sector. The reform committee has nearly finished its work and has established a new structure to develop new policies and procedures that will allow it to grow and develop programmes of significance to all its clients. It has the continuous support from the government and the key stakeholders like DAC, HI, ADD, CT, etc.

101. A newly established self-help organization in Cambodia for a specific type of disability is the Association of the Blind in Cambodia (ABC). ABC plays role in advocacy, awareness raising and development of information for its members at the central office in Phnom Penh. ABC also runs projects to support its members in Community Development such as training orientation, agriculture, small business, training in massage, computer and employment.

102. There are a few organizations working at the community level focusing on promoting ideas of self-help, building the capacity of community persons with disability and support the development of self-help groups. Some of these organizations have been exploring income generation projects, solidarity fund and the development of peer support groups. However, geographic coverage of these initiatives has been limited. For example, the Action on Disability and Development (ADD), the National Center of Disabled Persons (NCDP) and Social Service of Cambodia (SSC) focus in Kampong Spue province; ADD has expanded to Kampong Chhnang recently; and Handicap International-CABDIC programme works in four selected provinces.

103. Organizations in Cambodia, both those that are self-help organizations and those that have initiated self-help groups, meet various constraints in their development:

• A lack of training in leadership and management development.

104. People with disabilities themselves meet constraints too as they form self-help groups or organizations:

• Limited educational and/or training opportunities are available to people with disabilities

9. Regional Cooperation

105. With the adoption of the United Nations Standard Rules on the Equalization of Opportunities for Persons with Disabilities by the UN General Assembly in December 1993 and the ratification of Proclamation on Full Participation and Equality of People with Disabilities in the Asian and Pacific Region, ESCAP assumed a facilitating role in the regional cooperation on disability issues. The Agenda for Action for the Asian and Pacific Decade of Disabled Persons (1993-2002) sets out a number of targets in wide range of fields related to disability. A number of regional consultative meetings, workshops and conferences have been held to report on the progress of the implementation and to exchange knowledge and experiences on disability issues as well as to build regional and global networks and cooperation of all stakeholders involved in the disability and rehabilitation sector.

106. The DAC has a close relationship with ESCAP and has become a member of the Regional Inter-Agency Committee for Asia and the Pacific-RICAP Sub-Committee on Disabilityrelated Concerns (has now been converted into the Thematic Working Group on Disabilityrelated Concerns-TWGDC).

107. Representatives from DAC affiliated member organizations and secretariat have participated regularly in regional workshops, meetings, conferences and other events on disability-related issues, held in the region.

V. RELATIONSHIP BETWEEN DISABILITY AND POVERTY IN COUNTRY

A. Strengths of Existing Programs

108. The Cambodian Government has shown signs of interest in the situation of people with disabilities. During the seminar “Opening New Horizons for Cambodians with Disabilities” (Phnom Penh, 4th October 1999), the Prime Minister, with support from high-ranking international participants, pointed out the need for new strategies and tools to increase the integration of people with disabilities into society. Thus, the recent government interest in the issue will assist in institutionalising the approach to the reintegration of people with disabilities.

109. On the basis of the World Agenda of Action Concerning Persons with Disabilities of the United Nations, Cambodia has established a strong national task force on disability and rehabilitation sector called Disability Action Council (DAC), as a permanent National Coordination Body to coordinate, initiate and secure services necessary for people with disabilities to enjoy equal rights and obligations as well as opportunities and quality of life as others in the community.

B. Challenges and Gaps of the Current Programs

1. National Coordination

111. Many of the roles and responsibilities of relevant government ministries in the disability and rehabilitation sector remain unclear, and collaboration and co-ordination among them is limited. A National Plan of Action and monitoring, evaluation and reporting of its progress for the disability and rehabilitation sector has been developed by the DAC, but requires updating and ongoing follow-up. Coordination efforts are focused at the national level, with insufficient impact at the provincial level. It is not clear to what extent the National Coordination supports the advocacy movement and the inclusion and mainstreaming of persons with disability. There is a gap in the relationship between relevant government agencies and mainstream development NGOs.

112. There has also been a lack of vision in coordination and development of alliances outside the disability sector. So far, the discussion of policy and the development of service are occurring at a high level—government, DAC and international NGOs. These discussions need to be translated into programmes for implementation at the provincial and village levels.

2. Information and Database

113. Existing data on disability is fragmented (inaccurate), inconsistent (not solid, changing according to sources) and not systematically updated. There is a clear unbalance between data on physical disabilities and that for intellectual disabilities in terms of availability and consistency. Some organizations do have a database on their "clients". However, the majority of stakeholders could not afford to build up their own, due to lack of financial, human and time resources. There is no comprehensive approach to processing existing data. Generally, data is compiled without any clear idea of its eventual use.

114. Few stakeholders actually make an analysis and interpretation of their data. Thus few relevant findings had been released that could help to understand the issue in a holistic manner. Available data on disability is not uniform in terms of typology (classification of type of disability) and format, impeding any serious comparative study. However, tremendous efforts have been put into building uniformity, and the sector is now reaching an agreement on a common terminology and classification (see DAC database and CWD working groups).

115. There is no systematic or comprehensive approach to updating data after its initial collection. Some stakeholders only update data related to the persons with disability who benefit from their services. There is a strong likelihood of data overlapping and duplication, due to lack of coordination between different stakeholders. This problem results to inaccuracies and inconsistency of data.

116. It is impossible to undertake any factor analysis of the different components of the issue of disability using current databases and information resources. Because statistical analysis is limited, no correlation has been demonstrated between issues such as level of education and access to employment and gender and social discrimination. Few existing databases emphasize pertinent qualitative aspects of disability such as dependence, attitude, resentment, self-exclusion and cultural beliefs.

3. Disability Awareness

117. Few organizations carry out disability awareness activities. Among those that engage in raising awareness, their operational capacities are limited. There are many organizations that work to address disability and development issues, and disability awareness activities are often integrated into their programs. However, these activities are not always well coordinated, nor are they offered nation wide to provide the necessary geographic coverage. Awareness raising activities face constraints such as limited human and material resources, the absence of a standard methodology to gain media coverage and a higher profile, and geographic concentration. As a result, most disability organizations are limited in their ability to design and implement activities.

118. There is considerable scope to coordinate disability awareness activities in Cambodia at both the national and the local levels.

119. A national coordination committee/working group on disability awareness is still limited by their knowledge, mandate, and responsibility. Coordination of awareness raising activities should be reinforced and designed as a sustainable initiative. There is potentially a strong role for the Cambodian Disabled People’s Organization to support these coordinated approaches.

4. Women with Disability (WwD)

120. A fundamental issue when analyzing gaps in service provision is the lack of a “voice” by women with disabilities within the disability sector, women’s perspective on the numbers and specific needs of women with disabilities. One result of barriers to women’s participation in the sector is that many WwDs are not aware of disability programs, and therefore are not accessing services and resources.

121. With no access, and little opportunity to develop capacity, WwD have no presence in the range of organizations (government and non-government) that hold the resources. There is a resulting severe lack of representation by women with disabilities, particularly at decisionmaking levels.

5. Accessibility and Communication

122. Persons with disabilities experience difficulties in moving around the numerous obstacles of the built environment on a daily basis. Therefore, persons with disability and organizations representing them should be consulted on physical accessibility at the early planning stages of any new building or construction project.

123. Awareness of accessibility for people with disabilities is minimal outside of organizations working on the promotion of the rights of people with disabilities. Knowledge of accessibility issues among architects, planners, builders and funding bodies is extremely limited. This

124. At present the responsibility for building and construction permits is not clearly regulated. Also, the legislation on disability is still in a draft form. Hence, it is difficult at this stage to place responsibility for the implementation and monitoring of accessibility features on government bodies.

125. Currently in Cambodia there are many gaps in the area of communication for people with disabilities but many organizations are looking to expand their services. There is a general lack of availability of assistive devices and tools i.e. hearing aids, Braille machines, speech therapists, etc. Also, there is no certification of sign language interpreters in Cambodia. Khmer sign language is developing; however, it has not yet reached the completion stage. Reading materials in Braille also need to be more available. Schools exist for children with hearing and visual impairments but the current education system of Cambodia does not allow for full access to public education with their peers.

6. Education

126. The Government's stated education policy priority is to ensure equitable access and quality improvement for nine years of basic Education for All by 2010. (Draft Interim Poverty Reduction Strategy Paper). This policy was adopted by the Cabinet in late 2000.

127. However, education programmes for persons with disabilities have been implemented solely by non-governmental organizations and focus exclusively on children with disabilities. A limited number of special schools and classes exist, as do a few community-based initiatives. Collectively their services only provide education for a fraction of children with disabilities in Cambodia, less than one percent. These programmes are concentrated mainly in Phnom Penh and other urban areas and currently cater almost exclusively to children with physical disabilities and sensory impairments. All the special schools have integration in the mainstream as their ultimate goal, but there is no clear policy in this regard.

7. Training and Employment/Micro-enterprises

128. Access to vocational training services and income generation programs is limited by their geographical availability and by the types of services provided. Relatively little is known about the needs in most areas. Numbers and types of persons with disability have not been assessed and local market conditions are more or less unknown. Better co-ordination between service providers could be beneficial for trainees as well as training programmes. Improved coordination would ensure that local labor markets are not flooded and would bring new and needed skills to the local community.

129. The range of employment options after graduation is limited. Currently, the design of most training programs is based on the assumption that graduates will become self-employed. This is an option for some, but not all graduates. Agricultural training and agriculture-related training for income generation is unknown. Literacy and numeracy training are crucial for selfemployment and small enterprise management. However, trainees need to see a clear advantage coming from literacy.

130. Involvement of business people in the planning and implementation of pilot programmes is limited or absent. However, the private sector may eventually become the main employer for those graduates who do not opt for self-employment. Apprenticeship and job placement programmes (which could be paid for by the organization) should be promoted. More work is also needed to identify potential donors to support small and medium enterprises of persons with disability. Most agencies that support people with disabilities do not have the mandate, financial support or skills needed to manage small and medium enterprise development programs and projects.

8. Community Work with People with Disability

131. Gaps in services for Community Work with Disabled people (CWD) exist both in terms of geographic coverage and in types of services provided.

132. Geographical Distribution of Services. Most CWD agencies are generally working in central, southern and some western provinces. However, they are mainly only working in districts close to the town, and in secure areas with good road conditions. It is difficult to gain access to some areas because of lack of security, poor road conditions and large distances. This prevents many people with disabilities living in rural areas from benefiting from programmes.

133. The areas with no access to CWD projects are all former Khmer Rouge areas, such as Krong Pailin, Samlot in Battambang, Anlong Veng in Oddar Meanchey province and Veal Veng in Pursat province, and the northern and eastern areas such as Kampong Thom, Rattanakiri, Mondolkiri, Kratie, Stung Treng provinces. Geographic coverage is still limited to the large cities and towns.

134. Type of Services. Major gaps have been identified in the following types of service:

• Access to credit for people with disability: At this moment most CWD agencies are not providing credit to people with disabilities. In the past more agencies provided credit but they have now stopped because of lack of funds for this kind of project. The interest rates of mainstream credit agencies are so high that people with disabilities cannot access credit from them. A further problem is that people in the community often do not allow people with disabilities to join their credit group because they do not trust them to repay the loan to the group.

• People with certain types of disability: People with learning difficulty, HIV/AIDS and mental illness and intellectual disabilities do not have access to many income generation and vocational training programs because of the lack of awareness of these kinds of disabilities, and/or lack of knowledge to work with and train people with these types of disabilities.

• Skill training for specific groups: Most deaf and blind people living in rural areas do not have basic education or special training such as Braille and signing. They are excluded from mainstream development as well as from skill training provided by agencies in the disability sector. For deaf people, the situation is made worse because most people do not know how to communicate with them.

135. There is one further area in which the work of CWD sector might be strengthened. This concerns membership of CWD committee. Some CWD agencies are not motivated to send their representatives to this Committee. Some representatives do not attend the meetings regularly because they are very busy with their own work. ²⁰

9. Physical Rehabilitation and Assistive Devices.

136. Gaps in physical rehabilitation services cannot be identified unless members of the physical rehabilitation sector conduct a study to identify these gaps. However, there are service gaps at the community level, that have been identified by stakeholders at provincial and national workshops. For example, although there are 16 physical rehabilitation centers in Cambodia, service and geographical coverage is not well coordinated. This results in:

• overlapping services, whereby one individual or family received the same service from more than one provider;

10. Self-help Organization.

137. Currently in Cambodia there is one recognized self help organization representing the concerns and interests of people with disabilities. Although based in Phnom Penh, CDPO has begun to give attention to raising awareness and establishing networks with groups of people with disabilities across the country.

138. While this organization and others who have initiated self help groups are networking in many of the provinces, the concerns of rural people with disabilities themselves need to be further addressed.

139. Issues related to distance, bad road conditions, security and lack of support from local authorities have impeded the work of disability organizations and NGOs to support the development of self-help organizations in some parts of the country.

11. Recreation, Sport and Cultural Activities

140. There are few organizations that have considered sport and recreation as programmes and activities to be promoted. It is acknowledged that sport and recreation programmes for PWDs in Cambodia have not been sustainable for many years due to a lack of funds and human resources. Many of these programs are not included in the implementing agencies’ plans or budgets. Support and contribution of financial resources from government and the

20 Disability Action Council, Strategic Directions for Disability and Rehabilitation Sector in Cambodia, February

general public has not been at levels sufficient to sustain effective sport and recreational programs. . There is also a lack of awareness and understanding that sports and recreation are important social activities. However, there is an effort by DAC affiliated organizations and the National Paralympic Committee of Cambodia to facilitate institutional sustainability within certain programmes in the national rehabilitation sector.

VI. FRAMEWORK FOR PARTICIPATORY DEVELOPMENT

141. RETA 5956, “Identifying Disability Issues Related to Poverty Reduction” was carried out using a highly participatory approach. The project was conducted in close collaboration with governmental and non-governmental stakeholders and representatives of people with disabilities. The Ministry of Social Affair, Labour, Vocational Training and Youth Rehabilitation (MOSALVY) played a significant role in supporting the process, providing logistical support to the project such as office and support staff both at the national and provincial levels.

142. The research, analysis and recommendation that formed the principle outputs of the RETA were developed in consultations with key stakeholders, and through project site visits and provincial and national workshops. The purpose of the participatory approach was to bring stakeholders together to find common ground and to take ownership for the country strategy for mainstreaming disability related to poverty reduction.

143. At the inception visit of the Team Leader, the introductory process was made with over 20 people representing the Ministry of Social Affair, Labour, Vocational Training and Youth Rehabilitation; the Ministry of Health; the Ministry of Education, Youth and Sports; the Ministry of Women and Veteran Affairs; and the ADB office in Cambodia. Funding agencies, such as the Canadian International Development Agency, Civil Society Fund, AusAID and USAid, along with the Disability Action Council, Rehabilitation-sector NGOs and Self-help organizations of people with disabilities also participated in the inception consultations. The Disability Action Council (DAC) provided logistical support for the consultations. The introductory process attracted the interest of people wishing to collaborate in the participatory process.

144. In addition to the visits to three ministries and meetings with the government officials, the team leader and domestic specialists visited five disability projects in order to introduce the project, to assess the current institutional framework and stakeholders’ capacity to mainstream disability issues in poverty reduction programmes and to seek collaboration in the study, to be conducted by domestic specialists. The five projects were in national coordination, physical rehabilitation, community work with people with disability, and self-help organizations for people with disabilities and self-help group support.

145. Based on findings at the inception visit and information provided by the stakeholders, a background paper for the country was developed in Khmer and English to send to targeted participants prior to the provincial workshops. It provided all participants beforehand with the common understanding of the current disability situation in Cambodia. The background paper was improved after the each of the provincial workshops before it was submitted for discussion at the national workshop.

146. In the preparation for the provincial workshops, the domestic specialists made visits to all targeted stakeholders in order to introduce the project and prepare participants for their full involvement in the workshops. The two most populated provinces were selected for the workshops—Battambang, the Western province to be held on 23-24 May and Kampong Cham,

147. The workshops were designed to provide an opportunity for maxi