More than half of people with disabilities in Thailand do not receive welfare assistance from the government. This is unacceptable.
People with disabilities are among the most vulnerable, particularly the poor in remote areas. Allowing them to fall through the welfare cracks reflects the flawed system and the urgency for change.
According to the National Statistics Office, Thailand had 3.69 million people with disabilities in 2017. Yet only 1.64 million or 44.4% have disability cards to be eligible for state assistance. Nearly half (45.1%) of people who are left out by the system said their applications for disability cards to receive disability benefits were declined because the officials said they do not fit the disability categories determined by the government.
That's right. People with disabilities cannot get the help they need because the officials have the last say in whether they are disabled or not.
The welfare officials are not entirely to blame. The disability determination system or disability evaluation system is heavily based on medical diagnosis, not the needs of people with disabilities.
The problem may stem from the mainstream belief about disabilities that focuses on severe physical handicaps such as amputation, total visual and hearing impairments, paralysis, or other long-term and extreme conditions that obstruct physical functioning and mobility.
This notion overlooks external environmental factors that restrict the disabled people's movements. Social attitudes, unfriendly policy and building constraints, for example, prevent the disabled from having an active social life. The authorities also dismiss internal factors such as gender, education and financial situation that affect people with the same disability differently resulting in their different needs.
In fact, the 2007 Persons with Disabilities Empowerment Act has already covered these social and environmental factors. It defines persons with disabilities as persons who have difficulties in conducting daily life or in social participation as a result of impairments and other barriers. That said, this progressive legislation takes into account the need of disabled persons first and foremost, and does not require medical appraise.
But the official evaluation of disability is not in line with this law; therefore a large number of people with disabilities are barred from receiving disability benefits.
The current disability determination system has two major problems.
Firstly, the evaluation relies too heavily on medical diagnosis and the level of impairments without sufficiently considering the patients' actual limitations to perform activities and participate in the society.
Under this lopsided medical appraising, only the excessively mentally challenged are eligible for the activity and participation assessment. But there are various levels of mentally challenged patients. The majority are assessed for impairments and basic tasks such as walking and speaking only, and therefore might not fit the bill of the government's criteria. This means that the needs of people with disabilities cannot be fully and accurately identified.
Burdened by other work responsibilities, the physicians who conduct disability assessment do not have time for a thorough examination. There are usually no in-depth interviews or actual surveys of the patients' household environments to assess and answer their needs.
But instead, the physicians' assessment of the patients' capability in daily living and social participation is based on standard information about a particular disease or impairment and their general effects on functioning. Such general evaluation often results in inaccurate needs identification.
Secondly, the disability benefits are restricted to only seven categories of disability such as amputation, visual, hearing, mental and intellectual impairments. Due to this restriction, other forms of disabilities are overlooked.
Subsequently, those with mild disability or those not in the seven categories of disability are deemed not eligible to register for disability cards and disability benefits.
For example, a person who loses vision in one eye cannot get disability benefits because their condition does not fit the official definition of blindness.
In fact, those without severe levels of disability may still need special assistance when they also have other illnesses and if their external environment restricts their mobility and ability to take part in social activities.
Under the current system, people who lose hearing in only one ear are not eligible for disability cards and benefits. But if they also suffer panic attacks, do not have family to assist them, or live in an unsympathetic community, then they need help as much as those who lose vision in both eyes. It is, therefore, crucial to consider the patients' situations to assess their needs.
It is evident that the disability determination system is the crux of the problem. Here's how to improve it:
Firstly, the government must remove hurdles in the related assessments and registration system, to make it work smoothly and effectively. One aspect being omitted from the issue is a manpower shortage. Given health personnel constraints in time and expertise, other professionals such as social workers, physical therapists, occupational therapists, and psychotherapists should be looped in the system and given power to help assess the activity limitations of disabled people.
The system may use international standard such as those of World Heath Organization (WHO) questionnaires such as the ICF Checklist or WHODAS 2.0, which are designed to be responsive to the disabled people's needs. It is possible to adjust the standard questionnaires to suit local situations.
Secondly, the government must put the needs of the disabled people first and foremost. The determination system must take into consideration complete information of the effect of disability -- not only impairments but activity limitations in daily life. If the system shows that they are eligible for at least one disability benefit, then they should be registered as legally disabled.
Thirdly, the government must expand the categories of disability to be more inclusive and responsive to reality. A large number of people with disabilities are now excluded because help is available to only seven types of disability. Under a new system, if the patients face several barriers in engaging in daily activities and social participation, or are affected by a host of disabilities, they should be eligible for state assistance.
That also demands a new handbook on disability assessment that heeds the patients' needs and input from all stakeholders. The social workers and concerning health personnel must receive training to have a new understanding about disability and needs assessment procedures. Society, too, must be educated to be sensitive about the rights of people with disabilities to actively engage in society.
The current disability evaluation system is not in line with international standards nor the Thai law to empower people with disabilities. Change is urgently needed.
Revamping the bureaucratic system, however, is never easy. Change is also time-consuming. But it must happen. Otherwise, millions of vulnerable people will continue to fall through the welfare cracks from a flawed system. The current system robs disabled people of their rights. It is a crime. It must stop.
Phakphum Jatupitpornchan is a researcher at the Thailand Development Research Institute (TDRI). Policy analyses from the TDRI appear in the Bangkok Post on alternate Wednesdays.