Authors: Carolina Schiappacasse Melina Longoni Maria Alicia Paleo Myrtha Vitale
Health Policy
Affiliations: From the Department for Rehabilitation Medicine, British Hospital, Buenos Aires, Argentina (CS); APREPA Rehab Center, Rosario, Santa Fe, Argentina (ML); and IREP Rehab Center, Buenos Aires, Argentina (MAP, MV).
Correspondence: All correspondence and requests for reprints should be addressed to: Carolina Schiappacasse, Department for Rehabilitation Medicine, British Hospital, Finochietto 1623 Buenos Aires, Argentina.
Disclosures: Financial disclosure statements have been obtained, and no conflicts of interest have been reported by the authors or by any individuals in control of the content of this article.
0894-9115/14/9301(Suppl)-S39/0 American Journal of Physical Medicine & Rehabilitation Copyright * 2013 by Lippincott Williams & Wilkins
ANALYSIS
Reflecting on the World Report on Disability A Short Report from Argentina ABSTRACT Schiappacasse C, Longoni M, Paleo MA, Vitale M: Reflecting on the world report on disability: a short report from Argentina. Am J Phys Med Rehabil 2014;93(Suppl):S39YS41. In 2003, the National Survey of Persons with Disabilities identified 2,176,123 persons (7.1% of the total population of the country) with an impairment that affects some of the most important aspects of everyday life (walking, standing up, sitting down, seeing, hearing, learning, or general behavior). In Argentina, several laws support the rights of persons with disabilities. However, inappropriate implementation of these legislations, particularly in the inland provinces, results in shortage of services, low labor force participation, and poor housing conditions. The number of rehabilitation professionals is not sufficient to satisfy the demand for rehabilitation. Key Words:
Rehabilitation, Persons with Disability, Epidemiology, Policy
DOI: 10.1097/PHM.0000000000000020
BURDEN OF DISABILITY IN ARGENTINA Disability is a private and public issue that results in high costs for the national healthcare system. In Argentina, one of the main sources of disability-related information is the National Survey of Persons with Disabilities, which gathers information from a probabilistic sample of the population with disability.1,2 In 2003, the survey assessed the prevalence of impairments that affect some of the most important aspects of everyday life including walking, standing up, sitting down, seeing, hearing, learning, or general behavior. The National Survey of Persons with Disabilities identified 2,176,123 persons with disabilities corresponding to 7.1% of the total population; a total of 54% were women and 46% were men. A total of 20.6% of households in areas of 5,000 or more inhabitants include at least one person with a disability. The number of such households, in absolute terms, was 1,802,051. Disability-related data are also generated in the process of approving the Unique Certificate of Disability (UCD). The UCD is a public document approved by an interdisciplinary evaluation board that certifies disability in the entire Argentine territory.3 This certificate is used by individuals with disabilities to access health services and to receive social benefits established by legislation. The analysis of UCD data generates specific information about the population with certified disabilities in the country. The register also provides longitudinal data that are needed to adjust www.ajpmr.com
A Short Report from Argentina Copyright © 2013 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.
S39
FIGURE 1 Individuals with disability according to the type of disability and sex.
policies and programs to the increasing demand for healthcare and social services. A recent study conducted in 2011 showed that 2.4 persons per 1000 inhabitants obtained their UCD that year. Of these, 31% had motor/physical; 31%, mental; 15%, multiple; 14%, sensorial; and 9%, visceral impairments (Fig. 1). Women had a higher percentage of mental impairments, whereas men showed more physical/motor impairments (Fig. 2). The distribution of impairment by age shows a bimodal curve with peaks in the age ranges of 5Y14 yrs and 55Y64 yrs. Persons with disabilities have a high unemployment rate (particularly young adults), low occupational activity rates, and a low educational level. After the theoretical age of compulsory schooling, a high number of individuals with a certified disability do not continue to attend formal schools. Approximately 71.2% of the population of people with disabilities reported having health coverage, whereas 28.8% had no medical coverage. The percentage of those without insurance is lower than in the general population, in which approximately 36% is uninsured. The situation with respect to housing depends on the age of the individual. Children up to 14 yrs of age live with their parents, whereas adults live with their spouses. A large number of those older
than 65 yrs live alone. Among the individuals living in private homes, 87.7% have basic infrastructure in their houses including access to electricity, gas distribution network, and flushing toilets. A total of 45.9% do not have an adapted house, meaning that their dwelling was not suitable to meet their special needs. A total of 40.4% of the individuals with disability live in unfitted dwellings, critically overcrowded households and/or houses without basic infrastructure, and/or unpaved roads. With regard to transportation, 73.5% of individuals with a certified disability have access to public transportation within 300 m from their homes.
WHAT HAS BEEN DONE? Policies and Legislation Recognizing the rights of people with disabilities and the pressures of international organizations, a Unified System of Basic Services for Persons with Disabilities was established by the government of Argentina. Legislation has resulted in many new laws and policies. These include Law 24,901, which mandates the establishment of a System of Basic Services in Enabling and Comprehensive Rehabilitation for Persons with Disabilities. In addition,
FIGURE 2 Individuals with disability according to the type of disability.
S40
Schiappacasse et al.
Am. J. Phys. Med. Rehabil. & Vol. 93, No. 1 (Suppl), January 2014
Copyright © 2013 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.
Decree 762/97 establishes the Single System of Basic Services for Persons with Disabilities. These have contributed to a major change in the benefits system and will ensure the universality of care for people with disabilities through the integration of all disability-related policies and institutional and financial resources.
Human Resources There are different training centers for human resources in physical and rehabilitation medicine (PRM). However, the number of professionals who graduate every year is insufficient to satisfy the demand for rehabilitation. One of the reasons for this inadequate coverage is the large extension of the Argentine territory. Overall, there are 127 PRM institutions with 245 PRM specialists in Argentina. However, the PRM specialists are mainly concentrated on the regions of Buenos Aires, Santa Fe, and Cordoba, where more than 70% of all Argentine PRM specialists can be found.
Service Delivery Argentina has made a commitment to fully integrate people with disabilities into the society. The UCD is the key to access the health system and the social services and benefits for this important group, but it does not cover all the Argentine territory yet. In 2011, there were 20 provinces issuing the UCD and contributing data to the national UCD registry. In 2012, another province joined in, and it is expected that the UCD will be launched in two other provinces
www.ajpmr.com
by the end of 2013. It is worth noting that several attempts have been made to implement communitybased rehabilitation but outside the governmental framework.
CONCLUSIONS In Argentina, there are many policies and laws that support the rights of the person with a disability. Although much has been accomplished, these laws are not always properly implemented, particularly in the inland provinces. Unfortunately, there is little or no input from the Argentina Physical Medicine & Rehabilitation Society in the discussion of disability legislation. This has not changed since the publication of the World Report on Disability. Human resources distributed in the vast territory of Argentina are not enough to supply the needs of the rehabilitation institutions. There are few PRM specialists, and they are concentrated in the big cities. The Argentina Physical Medicine & Rehabilitation Society feels the need to be more active in the implementation of the World Report on Disability. REFERENCES 1. Departamento de Sistemas de Informacio´n, Servicio Nacional de Rehabilitacio´n, Ministerio de Salud de la Nacio´n: Anuario Estadı´stico Nacional sobre Discapacidad 2011. Available at: http://www.snr.gob.ar/uploads/ Anuario2011.pdf 2. Roulet D: La aplicacio´n de la CIF en la Argentina, desde el an˜o 2003. Ministerio de Salud de la Nacio´n Republica Argentina. Available at: http://www.snr.gov.ar/
A Short Report from Argentina Copyright © 2013 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.
S41
Health Policy
Affiliations: From the Department for Rehabilitation Medicine, British Hospital, Buenos Aires, Argentina (CS); APREPA Rehab Center, Rosario, Santa Fe, Argentina (ML); and IREP Rehab Center, Buenos Aires, Argentina (MAP, MV).
Correspondence: All correspondence and requests for reprints should be addressed to: Carolina Schiappacasse, Department for Rehabilitation Medicine, British Hospital, Finochietto 1623 Buenos Aires, Argentina.
Disclosures: Financial disclosure statements have been obtained, and no conflicts of interest have been reported by the authors or by any individuals in control of the content of this article.
0894-9115/14/9301(Suppl)-S39/0 American Journal of Physical Medicine & Rehabilitation Copyright * 2013 by Lippincott Williams & Wilkins
ANALYSIS
Reflecting on the World Report on Disability A Short Report from Argentina ABSTRACT Schiappacasse C, Longoni M, Paleo MA, Vitale M: Reflecting on the world report on disability: a short report from Argentina. Am J Phys Med Rehabil 2014;93(Suppl):S39YS41. In 2003, the National Survey of Persons with Disabilities identified 2,176,123 persons (7.1% of the total population of the country) with an impairment that affects some of the most important aspects of everyday life (walking, standing up, sitting down, seeing, hearing, learning, or general behavior). In Argentina, several laws support the rights of persons with disabilities. However, inappropriate implementation of these legislations, particularly in the inland provinces, results in shortage of services, low labor force participation, and poor housing conditions. The number of rehabilitation professionals is not sufficient to satisfy the demand for rehabilitation. Key Words:
Rehabilitation, Persons with Disability, Epidemiology, Policy
DOI: 10.1097/PHM.0000000000000020
BURDEN OF DISABILITY IN ARGENTINA Disability is a private and public issue that results in high costs for the national healthcare system. In Argentina, one of the main sources of disability-related information is the National Survey of Persons with Disabilities, which gathers information from a probabilistic sample of the population with disability.1,2 In 2003, the survey assessed the prevalence of impairments that affect some of the most important aspects of everyday life including walking, standing up, sitting down, seeing, hearing, learning, or general behavior. The National Survey of Persons with Disabilities identified 2,176,123 persons with disabilities corresponding to 7.1% of the total population; a total of 54% were women and 46% were men. A total of 20.6% of households in areas of 5,000 or more inhabitants include at least one person with a disability. The number of such households, in absolute terms, was 1,802,051. Disability-related data are also generated in the process of approving the Unique Certificate of Disability (UCD). The UCD is a public document approved by an interdisciplinary evaluation board that certifies disability in the entire Argentine territory.3 This certificate is used by individuals with disabilities to access health services and to receive social benefits established by legislation. The analysis of UCD data generates specific information about the population with certified disabilities in the country. The register also provides longitudinal data that are needed to adjust www.ajpmr.com
A Short Report from Argentina Copyright © 2013 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.
S39
FIGURE 1 Individuals with disability according to the type of disability and sex.
policies and programs to the increasing demand for healthcare and social services. A recent study conducted in 2011 showed that 2.4 persons per 1000 inhabitants obtained their UCD that year. Of these, 31% had motor/physical; 31%, mental; 15%, multiple; 14%, sensorial; and 9%, visceral impairments (Fig. 1). Women had a higher percentage of mental impairments, whereas men showed more physical/motor impairments (Fig. 2). The distribution of impairment by age shows a bimodal curve with peaks in the age ranges of 5Y14 yrs and 55Y64 yrs. Persons with disabilities have a high unemployment rate (particularly young adults), low occupational activity rates, and a low educational level. After the theoretical age of compulsory schooling, a high number of individuals with a certified disability do not continue to attend formal schools. Approximately 71.2% of the population of people with disabilities reported having health coverage, whereas 28.8% had no medical coverage. The percentage of those without insurance is lower than in the general population, in which approximately 36% is uninsured. The situation with respect to housing depends on the age of the individual. Children up to 14 yrs of age live with their parents, whereas adults live with their spouses. A large number of those older
than 65 yrs live alone. Among the individuals living in private homes, 87.7% have basic infrastructure in their houses including access to electricity, gas distribution network, and flushing toilets. A total of 45.9% do not have an adapted house, meaning that their dwelling was not suitable to meet their special needs. A total of 40.4% of the individuals with disability live in unfitted dwellings, critically overcrowded households and/or houses without basic infrastructure, and/or unpaved roads. With regard to transportation, 73.5% of individuals with a certified disability have access to public transportation within 300 m from their homes.
WHAT HAS BEEN DONE? Policies and Legislation Recognizing the rights of people with disabilities and the pressures of international organizations, a Unified System of Basic Services for Persons with Disabilities was established by the government of Argentina. Legislation has resulted in many new laws and policies. These include Law 24,901, which mandates the establishment of a System of Basic Services in Enabling and Comprehensive Rehabilitation for Persons with Disabilities. In addition,
FIGURE 2 Individuals with disability according to the type of disability.
S40
Schiappacasse et al.
Am. J. Phys. Med. Rehabil. & Vol. 93, No. 1 (Suppl), January 2014
Copyright © 2013 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.
Decree 762/97 establishes the Single System of Basic Services for Persons with Disabilities. These have contributed to a major change in the benefits system and will ensure the universality of care for people with disabilities through the integration of all disability-related policies and institutional and financial resources.
Human Resources There are different training centers for human resources in physical and rehabilitation medicine (PRM). However, the number of professionals who graduate every year is insufficient to satisfy the demand for rehabilitation. One of the reasons for this inadequate coverage is the large extension of the Argentine territory. Overall, there are 127 PRM institutions with 245 PRM specialists in Argentina. However, the PRM specialists are mainly concentrated on the regions of Buenos Aires, Santa Fe, and Cordoba, where more than 70% of all Argentine PRM specialists can be found.
Service Delivery Argentina has made a commitment to fully integrate people with disabilities into the society. The UCD is the key to access the health system and the social services and benefits for this important group, but it does not cover all the Argentine territory yet. In 2011, there were 20 provinces issuing the UCD and contributing data to the national UCD registry. In 2012, another province joined in, and it is expected that the UCD will be launched in two other provinces
www.ajpmr.com
by the end of 2013. It is worth noting that several attempts have been made to implement communitybased rehabilitation but outside the governmental framework.
CONCLUSIONS In Argentina, there are many policies and laws that support the rights of the person with a disability. Although much has been accomplished, these laws are not always properly implemented, particularly in the inland provinces. Unfortunately, there is little or no input from the Argentina Physical Medicine & Rehabilitation Society in the discussion of disability legislation. This has not changed since the publication of the World Report on Disability. Human resources distributed in the vast territory of Argentina are not enough to supply the needs of the rehabilitation institutions. There are few PRM specialists, and they are concentrated in the big cities. The Argentina Physical Medicine & Rehabilitation Society feels the need to be more active in the implementation of the World Report on Disability. REFERENCES 1. Departamento de Sistemas de Informacio´n, Servicio Nacional de Rehabilitacio´n, Ministerio de Salud de la Nacio´n: Anuario Estadı´stico Nacional sobre Discapacidad 2011. Available at: http://www.snr.gob.ar/uploads/ Anuario2011.pdf 2. Roulet D: La aplicacio´n de la CIF en la Argentina, desde el an˜o 2003. Ministerio de Salud de la Nacio´n Republica Argentina. Available at: http://www.snr.gov.ar/
A Short Report from Argentina Copyright © 2013 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.
S41
