Posted October 1999
|Special: Empowering the rural disabled in Asia and the Pacific|
People with a disability: the Cambodian scenario
R. Lindsay Semple
RATANA & Associates, Cambodia
The numbers of people afflicted with blindness and amputations are similar, constituting around 35% of all disabilities. Approximately 80% of blindness cases were either preventable or are curable. It has been forecast that polio will be eradicated from Cambodia by the year 2000 but - as illustrated below - it remains a grave threat to Cambodia's children.
The Ministry of Social Affairs, Labour, Vocational Training & Youth Rehabilitation (MoSALVY-formerly MoSALVA) estimated the number of disabled children under 18 years of age in Cambodia to be 32,000. At that time (1993-4) this figure represented 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. Diseases cause 65% of the disabilities among children, of which 27% are congenital, 5% due to domestic accidents, and 2% due to landmines.
The most common causes of paralysis in Cambodia are accidents and bullet wounds - most victims end up as quadriplegic or paraplegic. There is currently only one Centre in Cambodia for patients with spinal cord injuries, the Quadriplegic and Paraplegic Center (QPC) in Battambang.
Adult male amputees have a particular need to be contributors to their families and society. Many were soldiers and as such, they filled normal expected roles. When these men can no longer fill that role because of amputation, their intrinsic "value" as adults is largely eroded. Some turn to begging, whilst others become angry and reclusive. Economic autonomy is, therefore, a key element of rehabilitation in Cambodia. Programmes must help disabled people become positive economic contributors to their families and society.
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 healthcare system is not equipped to provide basic therapy or treatment, and government programmes continue to be largely dependent on NGO and IO assistance. Most programmes 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.
The QPC in Battambang opened in 1993. It is the only Centre that bridges post-rehabilitory evaluation of the patients undergoing treatment. The Centre serves, on a priority basis, the four provinces in the north-west of Cambodia and has a capacity of about thirty-six patients at a time. In addition to offering rehabilitation services to patients, the Centre also trains health workers at provincial hospitals in rehabilitation. The majority of the Centre’s funding comes from international donors.
The current estimates for the occurrence of landmines and other unexploded ordinance (UXOs) throughout the entire country, are staggering. The demining programme, now fully coordinated and implemented through the Cambodian Mines Action Centre (CMAC), includes many other agencies such as the Mines Advisory Group (MAG), Halo Trust, MPA Security Services in Cambodia, Milsearch, and a host of international suppliers and donor agencies. The operational budget for CMAC in 1999 is estimated at USD$ 12 million, but this pales into almost insignificance when compared with the cost (approximately USD$ 100,000) and time (approximately one month continuous work for 2 platoons) to totally clear one (1) hectare of land.
The work is divided into four (4) demining units or groups. Demining Unit 1 (DU# 1) operates in Banteay Meanchey and Battambang provinces, DU# 2 in Siem Reap, DU# 3 in Kampot, and DU# 4, previously under Handicap International financing, operated in Kompong Cham, Kompong Thom, and Kompong Chanang. The most heavily mined areas are in the north-west, and the Group 3 and 4 platoons (a team of around 40 men) are likely to be transferred to these identified and mapped hotspots or targets. Many UXOs remain in the eastern part of the country as a reminder of the illegal and unsanctioned USAF raids during the Vietnam war.
CMAC have introduced a logical sequencing and logistical approach to the problem. Demining in the less arable lands is given a lower priority than releasing previously productive lands back into production. Complete reduction can be counterbalanced by partial reduction to allow access for villagers to wells and their fields and along defined pathways, whilst leaving the mines located in bush or unproductive areas.
Demining proceeds after a pre- and post demining feasibility and socio-economic study, to ensure that those lands that are integral to government or donor-assisted agricultural programmes, are in fact utilised for that expressed purpose.
There is a strong positive correlation between the existence of mines and motor disability in Cambodia.
In particular, the MIDB project will assume responsibility for the provinces previously covered by the Mines Advisory Group (MAG), which included Battambang, Pursat, Banteay Meanchey, Siem Reap, and Kompong Thom. Data gathering staff will be deployed in a total of 15 provinces.
The provinces of Preah Vihear, Koh Kong, Kompong Som (Sihanoukville), and Kandal, as well as the autonomous region of Pailin, will also be included in regular reporting on mine incidents. In addition, field staff will be deployed to cover Special Coverage Zones (SPZs) where it has been traditionally difficult to gather data due to inadequate access or security problems. A total of ten SPZs have been identified. All available historical and updated data will be collated concerning both landmine and unexploded ordinance (UXOs) incidents. Within the SPZs, 2 or 3 districts will be selected on a priority needs basis, such as Samlot, Anlong Veng, Veal Veng, Thma Pouk, as well as any other areas where there are major gaps in the mine incident data.
By the beginning of 1999, a total of 26 field staff will be deployed throughout Cambodia as part of the national database network. HI has been co-ordinating with MAG in order to ensure a smooth transition to this next phase of the project’s operations.
The overall mine incident situation in Cambodia for the most recent reporting month of October 1998 shows a slight decline from 1997. A tota1 of 1,034 casualties have been reported through to October, 1998, compared to 1,184 reported casualties for the same period in 1997. The most seriously affected are the areas around Samraong district in Oddar Meanchey, and Samlot district in Battambang. The most notable change has been the reintegration (and ultimate demobilisation) of the military forces after the elections in September, 1998, and formation of the newly elected government in January, 1999.
In 1995, a joint Ministry-NGO Task Force was formed to develop a national strategy for the continuation, development and coordination of appropriate programmes, services and support for, and with, disabled people. Even though the Task Force recognised that several agencies have started "Community-based Work with Disabled People" (CWD), two important gaps exist. Firstly, severely disabled adults with no family and no one willing or able to help are not covered by any agency or governmental body. Secondly, activities to prevent disabilities are few and far between.
The need for training and increased work opportunities in the rural areas has also been recognised by the Ministry of Education, Youth and Sports (MoEYS) in a Strategy Plan it has developed together with other ministries, including the Ministry of Rural Development (MoRD), involved in Technical, Vocational Education & Training (TVET).
The "Vocational Training to Alleviate Poverty" (VTAP) focuses on providing more mobile rather than centre-based training specifically aimed at socially disadvantaged groups such as women and the disabled. Mobile courses tend to be short and have, for the most part, been oriented towards agriculture. Since the training is implemented in the trainees’ own environment, the learning process is easier, immediately transferable, and therefore, more accelerated.
One programme specifically working with the agricultural sector in Battambang province and whose beneficiaries include people with disabilities is Action Nord Sud (ANS). ANS trains families in pig and poultry husbandry, tree nurseries, as well as implementing agricultural irrigation and veterinary vaccination programmes.
Amputees, whose number is estimated at 30,000-40,000, constitute the major group of disabled people among adults in Cambodia. There are also nearly as many people with paralysis from polio. There are currently seven agencies, working in fifteen workshops, who produce prosthetics. These include the American Red Cross (AmRC), Cambodia Trust (CT), Catholic Office for Emergency Relief and Refugees (COERR), Handicap International (HI), International Committee of the Red Cross (ICRC), Foundation for the Support of the United Nations (FSUN) and Veterans International (VI).
The main organisations which produce wheelchairs are JRS/Mekong and VI. Most NGOs purchase their wheelchairs from JRS/Mekong and they distribute them for free to patients through the orthopedic workshops or in the villages. HI produces a tricycle, which it also distributes free of charge. Any wheelchair or tricycle repairs are usually the responsibility of the patient. Crutches are also distributed free of charge. These are either purchased by the NGOs from ICRC or are produced by the NGOs themselves, as is the case with HI.
There are currently several NGOs running CWD programs. These include ADD, AFSC, VI, the "Programme for Economic & Social Rehabilitation" (PRES-HI), Khemara, Maryknoll and Servants.
The PRES programme addresses the needs of disabled persons through a more community-based approach using existing rural resources such as village volunteers and self-help groups. PRES covers villages in the eight most populated provinces of Cambodia, reaching persons who are both severely disabled and economically disadvantaged in order to develop their physical autonomy, economic independence and social integration.
The HI programme initiative for "Capacity Building for People with Disability in the Community" (CABDIC), focuses on the concerns of disabled persons within their environment. Existing constraints to integration and acceptance of the individual’s disability within rural communities will be identified through situation analysis, either individually or with the assistance of their relatives, and collectively, through the formation of self-help groups. The expected output will be a range of solutions that will raise the self-esteem of the disabled within their own community, and identify areas where further assistance is required.
The programme in Sisophon, Kompong Cham and Takeo, will utilise the knowledge and experience of disabled children as the principle prime-movers in self-help groups.
As an essential complement to existing institutional services, the CABDIC programme will progressively evolve into a local NGO. The "Programme for Economic & Social Rehabilitation" (PRES-HI) will then refocus on provincial rehabilitation centres, and specifically focused on the economic support and integrative programmes required for people with disability.
Due to the seasonal nature of agriculture, off-farm activities are crucial to farmers who must earn supplementary income. Therefore, training in such activities is important. In addition, there is insufficient monitoring and evaluation of training effectiveness, in terms of assistance with finding employment. Often disabled people cannot attend these centres because they are not mobile or because they cannot leave their families for an extended period of time. Others simply cannot read and write. Few programmes exist that provide mobile, short-term, on-the-job, apprenticeship-style training, nor are most programmes able to reach the disabled in their own businesses. There is also a need for programmes to facilitate similar and equivalent access to available credit schemes.
In terms of the post-production phase of agricultural operations, little attention has been afforded thus far in development plans to such value-added, small-scale processing and post-farm gate marketing enterprises.
Specific sectors such as the safe use of agro-chemicals and pesticides (refer to FAO IPM), accident prevention and safe handling of agriculture machinery, tools and implements (refer to ILO initiatives and aligned INGOs), are major issues that can have a short-term effect on curtailing the number of disabilities. Safe work practices and concomitant accident prevention training becomes more imperative. Other sectors that may influence the number of people with disabilities include dietary-deficiencies (such as PEM, and vitamin A deficiency-induced blindness, an area supported through Helen Keller International), water sanitation and safe water supplies to reduce disease-related disabilities.
A review of the set-up requirements and operational costs for a mushroom enterprise in peri-urban Phnom Penh, indicated that the margins would be favourable and competitive with similar types of mushrooms currently imported from Vietnam, and sold in western-style supermarket outlets. The Save the Children Australia [SCA] programme in Kompong Cham province, and Concern Worldwide in Pursat province, are currently promoting the development of straw mushroom production. The Australian Catholic Relief (ACR) is apparently also recommending micro-enterprise development in mushroom cultivation. The Cambodian Chamber of Commerce has recently received an expression of interest for the export of straw mushrooms from Cambodia to Singapore. Mushroom cultivation is taught as one of the modules in Don Bosco’s 2-year curriculum on horticultural development, and is a crop with which many local Khmers are apparently already familiar.
The United Community of Cambodia (UCC) and the Jesuit Service (JS) also offer curricula for the disabled in agricultural and horticultural techniques. Similarly, the European Union through PRASAC and in conjunction with World Vision International (WCI-C), has established a micro-enterprise development centre located in Battambang.
An extremely interesting enterprise development initiative being supported by Youth With Mission (YWAM), is the "Hagar project". This project provides income opportunities for underprivileged groups in Phnom Penh, by selling soy milk and curd in locally fabricated stainless steel vats mounted on food carts, which is enough for one day’s street sales. YWAM plans to fully integrate and extend the programme by growing soybeans in Kompong Thom and Kompong Cham, two (2) provinces in close proximity to the capital Phnom Penh. Their current processing techniques can extend the life of the milk product for a maximum of three (3) days. Alternative UHT-type packaging could assist in broadening the shelf-life for the more up-market consumers, but no plans are envisaged at this stage to pursue a more capital-intensive operation. The brand with which they would have to remain both cost- and quality-competitive is Yeo’s ®, manufactured in Singapore by YSF enterprises with imported Canadian soybeans.
The production of soy sauce would be an alternative for lower quality produce. Apparently, there are currently five (5) local businesses employing between 10-25 people making soy sauce, and although there may be a local perception that imported products are better quality and up to sanitary/hygienic standards, the National Institute of Management (NIM) indicates that the market is far from saturated.
Other potential agricultural and agro-processing enterprises that would lend themselves to small-scale rural development are:
The key areas to consider in high-value horticultural production for fresh consumption revolve around maintaining quality to be competitive with current imports.
The establishment of cool-stores, canning and other alternative processing (mixed pickles and sauces; mixed fruit juices) should be considered in order to extend the products’ shelf-life window, maintain throughput supplies, and to fully utilise poorer quality produce. This could conceivably cover fruits, such as mangoes, jackfruit, litchi, rambutan, citrus, papaya, and pineapple, that are under grade specifications.
This appears to be a little way down the track under Cambodian conditions, and will not necessarily be farmer-driven, as it would require some economies of scale (the formation of co-operatives of some kind) as well as credit facilities. The "Centre d’Etude et de Developpment Agricole Cambodgien" (CEDAC), a local non-government organisation (LNGO), is researching the opportunities for developing produce co-operatives with SOFINCO, who are also planning to develop a co-operative based family rubber production enterprise in 1999.
Small micro-enterprise processing opportunities exist to service rural markets, but it would appear that generally, processing at economies of scale would be best suited to commercially-sustainable private investment. The necessary production throughput could be secured by supporting out-growers schemes with existing peri-urban, garden-type enterprises. Food preservation and drying techniques are being taught by YNAM and Don Bosco, where all the expected graduates from the first course (taught in conjunction with GTZ) are likely to be used as trainers for other interested NGOs.
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 programme providing loans and grants specifically to disabled persons, the other programmes are known to include the disabled among their beneficiaries.
Affordable micro-credit is almost a prerequisite for small-scale business development, and there is little value in skills or vocational training without the necessary investment capability.
Financially sustainable poverty lending schemes are currently charging between 3-5% monthly interest (Holmes, 1998), and require participation in savings programmes. Credit is about lending and repayment, and by definition, is not a grant. However, in some circumstances, grants may be considered as the only viable option. Village banking micro-credit schemes which provide small-value loans and require regular repayments are not always suitable for agricultural development, even though shorter terms connotes less risk for the provider. Schemes that extend the terms of repayment throughout a cropping season have higher losses and defaults on repayments. Obviously, the financial capability of the provider is directly proportional to their portfolio of debtors being in a position to repay outstanding loans.
The 14th Regional Inter-Agency Committee for Asia and the Pacific (RICAP) Sub-Committee on Disability-Related Concerns organised by the Economic and Social Commission for Asia and the Pacific (ESCAP) was held in May, 1997. As part of this regional forum, FAO tabled: "Round Table Meeting on the Integration of Disabled People in Agriculture and Agro-Industry Systems" to further explain the objectives and strategies it has targeted as part of the Ad Hoc Committee on Disability in Agriculture, FAO, Rome.
Proceeds of the round-table were published in November 1997 as: "The Integration of Disabled People in Agriculture and Agro-Industry Systems" offering the full papers that were presented in the Report of the Round Table Meeting. It presents the situation of disabled people in several Asian countries. A subsequent compilation paper was written on: "Country Case Studies on Cambodia, Lao PDR, Thailand and Vietnam, on Strategies for Rural Disabled with a focus on agriculture, agro-processing and natural resources management based income generating activities".
This study collates available information on the status of disabled persons in the four identified countries. It reviews in summary whether people with a disability are adequately covered in existing developmental plans, and if they are being adequately catered for in employment opportunities and income generating activities.
The United Nations Administrative Committee on Co-ordination (ACC) established the Network on Rural Development and Food security in April 1997. This committee is the highest administrative body within the United Nations system. The Network has been endorsed and supported by the UN Secretary-General and the Heads of 20 United Nations organisations. It is jointly managed by FAO and IFAD, in close co-operation with WFP. In addition, IFAD manages and maintains the on-line ACC Evaluation Knowledge Web (EVAK), a specialised evaluation forum that provides an opportunity for interested donors, governments, NGOs and others to exchange knowledge on selected topics such as land tenure, migrations, rural credit, etc.
Thematic Groups on Rural Development and Food Security have been established in countries within the UN Resident Co-ordinator System. They are usually facilitated by the FAO or UNDP Representative and are closely related to the development of a United Nations Development Assistance Framework (UNDAF) where they exist. The Thematic Group in Cambodia is developing activities in support of the food insecurity and vulnerability information and mapping system (FIVIMS).