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Posted July 1997

Special: Empowering the rural disabled in Asia and the Pacific
Motor disabled people in the agricultural and rural sector in Cambodia
Marc Bonnet
Programme Director, Handicap International
Phnom Penh, Cambodia


Introduction | Women | Cambodia 1 | Cambodia 2 | Lao PDR | Sri Lanka | Thailand 1 | Thailand 2 | Vietnam 1 | Vietnam 2 | Agroindustry | Horticulture | Strategies

Introduction

Its recent history of war, the presence of millions of landmines, continued armed conflict in certain areas, the lack of basic health care and the absolute poverty of the majority of its citizens all contribute to the fact that Cambodia is a country with a high number of disabled people, many of them in what would be their productive years.

A population census has not been held since 1962. However, according to a recent demographic survey done by the UNFPA and the National Institute of Statistics, there are 10.7 million inhabitants, 85% of whom live in rural areas and who are mainly involved in subsistence level activities. There are no national statistics available in Cambodia; however, it is thought that 2-3% of the population of Cambodia is disabled, making the per capita rate of disability one of the highest in the world. The division according to the disability, including severely disabled, is as follows (according to PRES findings in 8 provinces):

Amputation17.26%
Blind17.26%
Polio14.38%
Deaf/Mute13.66%
Mental Illness9.35%
Para/quadriplegic6.47%
Leprosy1.43%

"Severely disabled" is defined as above knee and double amputees, blind people, people with hemiplegia, paraplegia, quadriplegia, Hansen's disease and other conditions which restrict a person's ability to function in normal roles. According to recent estimates, there are approximately 30-40,000 amputees in Cambodia, most of them men between the ages of 19 and 35. Due to the large presence of landmines throughout the country (4-6 million), the number of amputees increases by about 150-200 each month. There are currently many de-mining activities; however, these are painstakingly slow. It will take many decades before land is clear for resettlement and for villagers to resume agricultural activities in the affected areas.

Blindness, together with amputations, constitutes the most prevalent form of disability in Cambodia. Approximately 80% of the blindness is either preventable or curable [5]. There are currently several campaigns run by HKI, UNICEF and WHO to combat disabilities such as blindness and polio. In the last National Immunization Day of the Polio Eradication Program (PEP), WHO in conjunction with the Ministry of Health immunized nearly 100% of children under 5. If this rate continues, it is predicted that polio will be eradicated from Cambodia by the year 2000.

The Ministry of Social Affairs, Labor and Veterans (MSALVA) produced a report in 1992-93 estimating the number of disabled children under 18 years of age in Cambodia to be 32,000 (approximately 21% of the total number of disabled). Polio is the major cause of disability among children in Cambodia followed by visual and hearing problems. In fact, diseases cause 65% of the disabilities among children, 27% is congenital, 5% is due to domestic accidents and 2% by mines.

The most common causes of paralysis in Cambodia is accidents and bullet wounds, most of whom end up as quadriplegic or paraplegic. There is currently only one center in Cambodia for patients with spinal cord injuries, which is the Quadriplegic and Paraplegic Center in Battambang.

Although the Ministry of Social Affairs, Labor and Veterans Affairs (MSALVA) is currently producing a database, there are as of yet no proper records on programs and services for the disabled. There is, however, much discussion on having disabled people register with MSALVA and possibly be issued identification cards, especially now that 43,000 soldiers are soon to be demobilized as part of the government reconstruction policy. Ten thousand of these soldiers, 4,000 of whom are disabled, will be transferred to the care of MSALVA. After demobilization, these former soldiers and their families will need training, rehabilitation and any other necessary means to reintegrate into society.

Needs and constraints

Socio-economic

As is true for many countries, poverty and disability in Cambodia are directly linked, with poverty being a contributing factor to the causes of disability as well as being a common result of being disabled. Not only is the stigma attached to disabled people strong and rarely challenged, individuals rarely have the resources or the reflex to offer help to people outside their own immediate family. As a result, disabled people are very often socially and economically marginalized.

Social and economic rehabilitation are thus closely linked in Cambodia. For adults, being able to contribute to the family by working and/or earning money is an important determinant of status in Cambodian society. Someone who cannot or does not work is either forever dependent on their parents, often seen as a burden to the family, or abandoned to fend for themselves. Husbands and wives often leave their disabled spouses. Adult male amputees especially have a particular need to be contributors to their families and society. Previously as soldiers they filled normal expected roles; when they can no longer fill that role because of the amputation, their "value" as adults is erased. Some turn to begging; others become angry and reclusive. Economic autonomy is, therefore, a key element of rehabilitation in Cambodia. Programs must help disabled people become economic contributors to their families and society.

In general, access to education, health and employment opportunities for disabled people is very limited, as it also is for many non-disabled people living and working in the rural areas. The country has a very under-developed infrastructure and the lack of proper transportation systems hampers the delivery of community-based programs. Security problems and heavy rain often result in remote villages being inaccessible for several months. The healthcare system is not equipped to provide basic therapy or treatment, and government programs continue to be largely dependent on NGO and IO assistance. Most programs and services at this point are based in Phnom Penh and a few provincial capitals, but a large majority of people in the rural areas have very limited services

Education and training

Many disabled children do not attend school for the same reasons as non-disabled children in the rural areas: lack of money to pay for the materials and distance. However, sometimes parents do not believe disabled children can or will benefit from education. Teachers may deny entrance to classes if a child has a disability the teacher suspects is contagious; often the school is physically inaccessible for mobility impaired children. It is, therefore, essential that parents, teachers and fellow classmates be given information to encourage the inclusion of disabled children and to adapt school facilities and school activities.

It is also important to increase disabled people's access to mainstream training opportunities. A large majority of the disabled in Cambodia are rural dwellers with low educational levels and little experience other than farming and soldiering. There is a need to train these farmers to raise agricultural productivity and to diversify away from rice production.

Due to the seasonal nature of agriculture, off-farm activities are crucial for farmers to earn supplementary income; thus there is also a need to train farmers in such activities. There are vocational training schools and centres but many of these are located in or near Phnom Penh. The majority of these vocational schools teach skills that are not useful for the rural areas and are often not driven by demand or by the local market. In addition, there is insufficient post-training follow-up and assistance with finding employment. Often disabled people cannot attend these centers because they are not mobile or because they cannot leave their families for an extended period of time; others cannot read and write. Few programs exist that provide mobile, short-term training, apprenticeship-style training or that reach the disabled in their own home. Most disabled do not have the funds to start up their own business; thus there is also a need for programs to facilitate their access to credit schemes.

Health and rehabilitation

Many primary and secondary disabilities in Cambodia could be prevented, and there is an urgent need for information, training and community awareness on prevention measures. Two major groups of disabled people can benefit greatly from physical and occupational therapy: disabled children and adults with recently acquired disabilities. However, Cambodia's health care system is not equipped to provide basic therapy to these two groups, which means that their disabilities often become more severe than "necessary". At this point, no hospital in Cambodia can offer therapy that is consistent and in the context of normal everyday activities as in the case of a disabled child, for example. Rehabilitation takes time and perseverance. For both disabled children and recently disabled adults, community and home-based care is necessary.

In this regard, the Quadriplegic and Paraplegic Center in Battambang is the only center in Cambodia which bridges the life of the patient in the care center and back home. Open since 1993, the center serves on a priority basis four provinces in the north-west of Cambodia and has a capacity of thirty-six patients at a time. In addition to offering rehabilitation services to patients, the center also trains health workers at provincial hospitals in rehabilitation techniques particular to this group of patients. The majority of the center's funding comes from international donors.

Empowerment of disabled people

As a result of the First Seminar of Disabled People, held in Cambodia in September 1994, the Cambodian Disabled People's Organization (CDPO) was established. This organization acts in an advisory capacity to all disabled persons in Cambodia, providing advocacy, advice and referral to services. CDPO is a self-help, self-representation, cross-disability organization. NGOs of the Rehabilitation Sector support the CDPO in several ways: with funding, advice in organizational development and in joint projects to raise awareness of disability issues.

The National Center for Disabled People (NCDP) opened in 1994 as a result of a national seminar on rehabilitation held earlier that year. The NCDP is run by disabled persons for disabled persons and serves as a resource to individuals and the community at large. NCDP includes a retail business outlet for products and services created by disabled persons, a library/resource center, meeting rooms and training facilities and a restaurant. The purpose of the center is to provide a means of income generation for disabled persons by offering for sale their products and services as well as to provide a source of information. The NCDP functions under the auspices of MSALVA, who recently offered the use of a new building. During 1997, NCDP plans to start a job placement program, which will include a database on the available skills, job preference and training needs of people with disabilities.

Since the MSALVA Task Force on Disability Issues was convened only as a temporary body, it recommended that a body be formed to monitor and implement the recommendations and actions plans of the Task Force. The Disability Action Committee (DAC), which meets once each month, includes representatives of MSALVA, CDPO, NCDP as well as NGOs and IOs involved in the rehabilitation sector and has been active since December 1996.

Prospects for income earning

According to the recent demographic survey of Cambodia conducted by the National Institute of Statistics, 81.6% of employed persons were in the primary sector (agriculture, hunting and forestry, fishing) and half of the population belongs to the active labour force (15-64).

Most of the working population of Cambodia is engaged in small-scale operations, either in the rural areas on farms or as owners or family workers in towns, primarily in informal sector businesses. Less than 10% of the labor force is in wage employment. Exact figures on the number of disabled persons employed in the general population are not available. In Phnom Penh, disabled persons are often employed by NGOs; others work in handicraft centers; some form part of the large number of mototaxi drivers who come to the city from the rural areas especially during the dry season.

Agricultural Sector

The agricultural sector in Cambodia has a wide scope of possibilities if the political situation and security conditions improve; this including the clearing of landmines on farmable land. The climate is varied from the mountains in Mondolgiri and Ratanakiri, to the plains in Battambang, and the western sea coast. The rich Tonle Sap basin has enormous prospects for agricultural activities throughout the year. The soil is very rich after its flooding in the rainy season. The Tonle Sap is the biggest and richest source for fresh water fish in the world.

For the 85% of Cambodians who live in the rural areas, survival depends mainly on agriculture, which is predominantly rice cultivation done at a subsistence level. Training and technology transfer, however, could help farmers raise agricultural productivity and diversify away from rice production to vegetables, poultry and livestock raising and fish farming. In addition, as pointed out by the Ministry of Education, Youth and Sports (MOEYS) in its Strategy Plan, work opportunities in the rural areas can also be increased by adapting appropriate technologies which lead to the utilization of locally available resources and non-farm activities.

Areas of special interest for the creation of (self) employment or for the improvement of living conditions in the rural areas are listed below. Improved and diversified production, processing, preservation, storage and marketing is essential. Possibilities exist in the coconut tree, which is supposed to be 100% productive but whose potential has not been exploited so far, improved palm sugar processing, vegetable production, fruit cultivation, cash crops like cashew and cotton, castor seed cultivation, extraction of vegetable oils, making poultry feed, frog and eel raising, pig raisin, poultry and sericulture.

The French government has recently signed an agreement with the Royal Government of Cambodia to revive and develop sericulture. At present very little is done in this field. Examples and expertise can be sought from neighbouring countries. Other related activities that need to be improved include mulberry cultivation, silk worm rearing, dyes and dyeing techniques, and production of handicrafts in silk. Many NGOs are already working in this field for training and employment (World Vision , International Catholic Migration Committee, Maryknoll, Khemara, Tabitha and others).

Non-farm activities

Today only 44% of farmers' income in Cambodia is derived from farming; therefore, off-farm activities are crucial for farmers to earn supplementary income.

Working along those lines, programs such as the UNDP/ILO Vocational Training for Employment Generation Project (VTEG) and Vocational Training for the Alleviation of Poverty Project (VTAP) offered training in both technical as well as agricultural skills. An evaluation made of VTEG found, however, agriculture-oriented and courses are much less expensive than technical courses that are institution-based. On the other hand, technical graduates earned a more stable income, better economic opportunities and were more eligible for loans. In its progress report, VTEG lists the following skills as achieving the highest occupational employment rate: plumbing, poultry raising and television repair at 100%; frog/eel raising. motor rewinding, pig rearing and shell craft over 90%; basket/bamboo production, electrical engineering, duck rearing and weaving 80% or more.

Good prospects for off-farm income implementation may result from the following food processing and preservation, tanning, leather processing (keeping in mind the polluting aspect of this industry), simple rubber and latex products, and adaptation , production, maintenance and repair of agricultural implements.

Credit and the private sector

Several local and international NGOs offer credit, with or without interest, to the agricultural and commercial sectors in Cambodia. These include ACLEDA, GRET, ANS and HI/PRES. While PRES is the only program providing loans and grants only to disabled persons, the other programs are known to include the disabled among their beneficiaries.

According to the Ministry of Agriculture, quite a few projects have been approved for private investment in the agro-based industry. This will call for skilled and semi-skilled workers which is absent at the moment. But it is to be seen how many really take off because everything depends on the stability and security of the country.

Recommendations for action

The needs of disabled people in Cambodia are enormous and are likely to increase in the future. First of all, it is essential that access to education, training, health and employment opportunities for rural motor disabled people, as described earlier, be improved (this argument can be made for the rural sector as a whole). However, one of the largest constraints today is the fact that there are no national statistics or specific information are available on the exact situation of disabled people in the country. Due to the war and security reasons, those statistics that do exist are usually estimates.

While there are many programs offering services to disabled people, very few of these work exclusively in the rural areas. In general, programs that do work in the rural areas may include disabled people among their beneficiaries, but their reports and evaluations do not focus on the situation of disabled persons. Very little information exists on the status of rural motor disabled people in Cambodia, even though a large majority of the population as a whole is rural.

While it has been recognized that there should be more focus on income-generating activities for disabled people, no information is available on suitable industries and ventures for the disabled working in the agricultural sector.

A random survey needs to be done of as many provinces as are accessible to identify motor disabled persons living and working not only in the rural sector but in the country as a whole by number, sex, age, family status, employment opportunities, health and education etc... Such a study should look at training facilities and cottage industries that exist or may have existed in the past and see if these would be suitable in the country today. It would also appear as a priority to identify what disabled people want to do and their existing means of living. Along these lines, such a survey should also identify and collect information about programs working with rural motor disabled in other countries and evaluate whether these would be appropriate for Cambodia.

As a result of this survey, projects on vocational training in the rural areas could be initiated in collaboration with NGOs and IOs currently working in this sector. These NGOs and IOs should be encouraged to give priority to including disabled persons in their programs, whether these be vocational training, agriculture or credit. Working with existing resources will also facilitate follow-up and evaluation of programs. It is important that programs establish income-generating activities that provide a stable and regular income so that people will be encouraged to stay in the provinces during the dry season and not leave for Phnom Penh.

Emphasis should be given to mobile courses and to job training that would fit trainees' level of education, environment, learning abilities etc... Judging by present experience, mobile courses need less investment and infrastructure and they are more suitable to the people living in rural areas . Programs should also identify persons already involved in farming activities or in other productive rural activities and they should be encouraged to become non-formal trainers for the target population.

Importance should be given to post training follow up, refresher courses and credit facilities. Training alone is not enough to make the people productive. Follow up should be made over a longer period (for at least two years) to see and study the problems in a regular manner. Refresher courses are necessary to create a common platform for the beneficiaries so that they can interact and discuss amongst themselves to evaluate the positive and negative aspects. It is very important that initiatives come from the beneficiaries so that each one is responsible for what he/she is doing.

Specialized personnel is to be trained to follow up on such projects as well as trainers. As much as possible, this personnel should be selected from the areas of the program since they would be familiar with the target population.


Empowering the rural disabled: Introduction | Women | Cambodia 1 | Cambodia 2 | Lao PDR | Sri Lanka | Thailand 1 | Thailand 2 | Vietnam 1 | Vietnam 2 | Agroindustry | Horticulture | Strategies



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