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Overview
People with disabilities have always been regarded as being special and rightfully so. Despite this classification however, most of them in many societies still face obstacles that inhibit them from exercising their abilities effectively hindering their full participation in societal activities (Mooney et al. 2008, p. 67).
The United Nations Standard Rules on the Equalization of Opportunities/ or Persons’ with disabilities considers disability as a human rights issue (Dobson 2001, p. 100). Traditionally, disabled people have been marginalised in social and economic development programs by governments of different jurisdictions (Middleton 1999,P 12).
While progress has been made on many fronts in many regions of the world, the depth of the problems affecting disabled persons still paints a bleak situation for the vast majority of these people (Gordon et al 2000, p. 28).
Even in cases where concrete steps have been taken to reduce the marginalization of persons with disabilities while increasing their integration, there is still more that needs to be done (Beresford 2002, p. 147).
In such situations, there have been efforts promoting changes in the social fabric that includes liberation and empowerment of people with disabilities effectively enhancing their equalisation opportunities (Read et al 2010, p. 130). Such a community is the Jeddah community in Saudi Arabia whose initiatives towards promoting equal opportunity access by persons with disabilities has been exemplary.
Given Jeddah’s position and location in Saudi Arabia, it’s important to note therefore that some information that will be referred to here will be from Saudi Arabia policy documents on persons with disability (Marchant & Jones 2000, p. 72). Unless specified, the overall country policy is assumed to apply to all of Saudi Arabia including Jeddah.
Also, to note is that the analysis will pay special emphasis to children with disabilities. From time to time, the policy analysis may refer to the general policy that is present in Saudi Arabia or Jeddah without necessarily referring to children directly. However, since disabled persons include children, it should be assumed as such.
This theoretical perspective will first focus on the analysis of the general concept of disabled children care policy system in Saudi Arabia. There will also be a comparative analysis on the implementation of the disabled children policy in Jeddah and by extension Saudi Arabia.
Additionally, another comparative analysis will be carried out between the Jeddah policies and those of Egyptian and Emirates counterparts. The comparisons will be able to provide a clear picture of the Jeddah situation so that it will be easy to precisely come up with suited recommendations on what needs to be done.
General concept of disabled children cares policy system in Saudi Arabia
The care policy of disabled children in Jeddah is guided by the disability code of the country that lays down comprehensive mechanisms on the treatment of persons with disabilities (PSCDR 2011, P2).
The code generally refers to persons with disabilities without an explicit mention of children (Department of Health 1998, p. 13). However, because there is no discrimination on the basis of age on persons with disabilities the code is assumed to apply across the board.
The code consists of sixteen articles that define the terms associated with disability in Saudi Arabia, the role of the government in the welfare of disabled children, administration of the bodies concerned with disabled person, and the sources of funding of the bodies that formulate policies of persons with disabilities.
Article one considers disabled persons as those people with hindrances in terms of body, material, mental, communicative, academic and psychological capabilities (Colton and Roberts 2004, P 4).
According to the code a person is considered disabled if the hindrances inhibit his/her ability to meet the normal needs when compared with the person’s non-disabled counterparts. Specifically, persons with disabilities must be those that have visual, cognitive, motor, learning, speech, behavioral impediments and other impairments that require special care.
According to the code, the authorities must do everything possible to ensure prevention of occurrence of disabilities, habilitation and provision of welfare to the persons with disabilities. The code demands that the responsible authorities put in place medical, psychological informational and regulatory measures that will aid in preventing or minimizing the effect of disabilities.
The code demands that the state provide the persons with disabilities with welfare as necessitated by their level of disability and their medical as well as social situation.
Furthermore, the code requires that authorities provide habitation through a coordinated process that uses medical, social, psychological and educational facilities and services available to the state and private providers to enable persons with disability to achieve the highest degree of functional efficiency (McNeish et al (nd), p 9).
Habitation provided by the state is also required to ensure persons with disabilities are better equipped to adapt to their environmental needs besides increasing their level of independence.
One of the roles of the authorities according to the code’s article two is to encourage and guarantee welfare and habilitation services to persons with disabilities. The authorities are also required to help in raising funds for the disability courses through encouraging both institutions and individuals to contribute to disability oriented charitable activities.
The services that the government is required to guarantee include health, education, training and rehabilitation, work, culture and sports, information, complimentary services and social events.
Situation analysis
In Jeddah like it is in the larger Saudi Arabia, Sharia law emphasizes treatment of children with disabilities with dignity (Chaim 2007, p. 60). There have been concerted efforts focused on persons with disability especially after the launch of the social and economic development plans nearly twenty years ago.
The government provides appropriate welfare services to all children with disabilities as articulated in the country’s disabilities code. The services accorded by the government to children with disabilities are one so through the ministries of labour and social affairs, ministry of health and ministry of education (EBKSA 2000, p. 12).
Most services and programs concerning children with disabilities are based in the metropolitan areas of the country such as Jeddah.
In Jeddah, in line with the Saudi Arabia code of persons with disabilities and the Governorate’s goal of providing accessible and high quality services to all the residents, there have been developments that have specifically been designed to provide welfare services to children with disabilities.
They include daycare centres that provide rehabilitation services to children with special cases of disabilities between the ages of 3-12. These centres mainly work to help working parents whose commitments cannot allow them to provide enough care and attention.
There are also vocational rehabilitation centres in Jeddah that provide rehabilitation for males including young males who are not yet adults (EBKSA 2000, p. 16).
The trainees learn skills that make them competitive in the labour market. Besides, the Governorate has embarked on designing and development of “access all” infrastructure that ensures that physically challenged people including disabled children access them. Furthermore, there is a weekly bus to collect disabled people including children to take them to health centres, schools and social activities (Mufti 2000, p. 33).
Despite the developments however, there are a few issues that need to be addressed to ensure smooth implementation of the disabilities code in Jeddah and the larger Saudi Arabia.
There are no regular reports from the governorate on the number of children with disabilities that are specific on the types of disabilities and their distribution geographically (EBKSA 2000, p. 7). Additionally, there has been an overemphasis on the provision of healthcare services for the children with disabilities in Jeddah as oppose to the attention given to the children’s education and training.
Despite the existence of many royal foundations supporting children with disability, there is absolute lack of clarity on the type and quality of services that are rendered by these organizations (EBKSA 2000, p. 7). Additionally, there is need to emphasize on the improvement of services for persons as most of the resources from these foundations have so far been use in developing facilities and infrastructure.
Besides, there is need for organizations like the National Guard and the military to release statistics of children with disabilities for easier planning by governorates such as Jeddah. Currently, these institutions are extremely sensitive about such data rarely release it (Ham et al. 2004, p. 98).
The institutions catering for disabled children are mainly concentrated in Jeddah’s central areas. Though a good part of the governorate is urban, the outskirts are not as well served by these facilities as the central areas are (EBKSA 2000, p. 7).
Overall, the policy on the care of disabled children in Jeddah is exemplary. There is need however to polish on the areas highlighted above to improve on service delivery to children with disabilities.
KSA and Egypt
Unlike KSA, Egypt is more secular and information and statistics on persons with disability is readily available. The majority of causes of impairments in Egypt are caused by both economic and social factors.
The Egyptian policy on disability defines disabled persons as any individuals who are different from normal beings in terms of social, physical and psychological aspects to a level that warrants special attention, rehabilitation actions to help them achieve their potentials (Mont 2007, p. 72).
Though there have been subsequent amendments to the definition, the terms and the meanings remain largely the same. Compared to the KSA definition, the Egyptian one is a bit insensitive and shallow.
The definition limits its scope to people with mental, physical and psychological impairments leaving out people and in effect children with sensory and/hidden impairments. Additionally, the policy’s definition refers to normal people effectively implying that disabled people are not “normal”.
The policy has however been updated over the years to accommodate more groups of children with disability in Egypt to include those that are blind, had the use of only one eye, were ‘deaf and dumb’, have lost one or both upper limbs, have lost one or both lower limbs, or those that are considered to have severe or mild mental retardation.
By 1996, the categories of disabled people and children had been expended to include those that had polio, the deaf and dumb (Barnes & Mercer 2005, p. 147).
Like in KSA, there have been several laws and policies introduced in Egypt concerning the welfare if disabled people and children (Mufti 2000, p. 33). In 1950, the legislation on social welfare contained provisions dealing with the rehabilitation of disabled persons and children. After the 1952 revolution, four more laws were enacted by the Egyptian legislature that in order to secure the care of disabled people and children.
There is a marked difference in the implementation of these laws between Egypt and KSA. In KSA, the implementation is done by three ministries while in Egypt, it’s done by one; the Ministry of Social Affairs and Manpower. This responsibility is located on one department, an approach with both merits and demerits when compared to KSA in terms of coordination and communication.
One significant undoing of the Egyptian disability policy is the failure of reference to disability in other Egyptian laws (Marshall 2009, p. 87). Though the case can be compared to KSA, the Egyptian situation can is more severe because policy makers have developed a tendency to ignore disability issues in other departments (Gaad 2010, p. 84).
The lack of reference has led many bureaucrats in Egypt to view disability as merely a rehabilitation issue. It’s important to note that there have been no new legislations concerning disabled persons and children in Egypt in the last three decades. Compared to KSA therefore, The Egyptian care policy on disabled children is still archaic characterized with traditional, medical, individual as well as medical models of disability definition.
KSA and Emirates
The United Arab Emirates has perhaps the most comprehensive and well-defined policy on persons and children with disabilities among the three countries under discussion. Additionally, compared to KSA, and Egypt, the Emirates comprehensive statistics on persons and children with disabilities are easily available (Gaad 2010, p. 100).
The national as well as local governments have enacted legislations that ensure the welfare and rights of people with special needs are met (UNCRC 2001, p. 109). Unlike in KSA where the definition is more forthright, the definition in UAE considers people with impairments as people with special needs including disabled juveniles. Disabled people including juveniles in UAE constitute about 8% of the country’s total population.
The main categories of disability include persons and children with mental retardation, auditory impairment, physical and motor disability, autism and attention deficit disorder. The policy like that of KSA requires the above categories of persons and children are entitled to institutional care from both government and private hospitals.
The state through the Special Categories Welfare Department at the Ministry of Labour and Social Affairs has rolled out through government centres elaborate programs catering for the disabled children and their family members (WHO 2005, p. 56).
In the centres the government has ensured disabled people and children access health and safety requirements as dictated by their conditions as well as activities programs and services that help them cope with their situations.
Besides, Special Categories Welfare department has in place programs primarily aimed at promoting disabled persons and children’s social integration. The activities entail participation in religious and national activities as well as other international and sporting and camping events by people with disabilities.
Overall, compared with KSA, UAE has developed and implemented an elaborate policy on persons and children with disabilities.
Literature Review
According to JICA the definition of disability in KSA is contained in the Labor and Workman Law (Article 51) that defines disabled people as people who have been incapacitated through mental and/ or physical infirmity and as a result cannot perform or maintain a suitable job (2002, p. 11).
In the case of children, the disability is viewed through incapacitation to live normally as other children of the same age through performance of age dependent activities.
In KSA, the policy on persons and children with disabilities is formulated on the basis of gender. The policies on persons with disability in KSA are contained in the sixth national development plan that covered 1992-2000 (JICA 2002, p. 13).
In the plan, items covering disability issues articulate that the government will intensify follow up and provision of healthcare for persons with disabilities as articulated in the various laws and council resolutions. The seventh development plan that covers years 2001-2005 calls for the encouragement of cooperation between the different organizations dealing with persons and children with disability.
Additionally the plan urges the cooperatives, charities and organizations involved in disability courses to develop economic and social projects including hospitals, private clinics and sanatoriums for better delivery of the services.
Because of the weighty issue of gender and separation of sexes in most Muslim countries, rehabilitation facilities for males and females in KSA are separated. However, statistics justifying the distribution of these facilities is not scarce. Most of the vocational rehabilitation centers for training are male.
Women on the other hand women form the majority of participants of social rehabilitation centers. In many places there are few or no rehabilitation centres offering training to females with disabilities (Eide & Ingstad 2011, p. 125).
The central government is charged with the overall responsibility of formulating and implementing the policy on disabled persons and children (Ibrahim et al. 2006, p. 92). This is done through the ministries of labour and social affairs, ministry of health and ministry of education.
Through these ministries, special departments operate special facilities dispensing rehabilitation and social adaptation, healthcare, disease control and prevention and education programs for people with disabilities (JICA, p. 23).
Local governments too are involved in the implementation of the policies of disabled persons and children. According to Epstein & Limage (2008) nearly all of the services on disabled persons and children in KSA that are run by the local authorities are concentrated in the urban areas like Jeddah. Majority of rural populations and nomadic tribes have difficulty accessing these services.
It’s important to note that majority of people with disabilities in KSA; 58% live in the rural areas. In other cases, communication breakdowns or lack of it and minimal coordination and cooperation between public and private organizations involved in disability programs has led to a duplication of efforts in the programs Epstein & Limage 2008, p. 42).
There have been numerous measures to help disables people and children in KSA. These measures are grouped into prevention, identification and early intervention, medical services and rehabilitation, education, social services and community based rehabilitation.
Through the policy of prevention, identification and early intervention, the authorities and private charities have identifies areas where efforts are being made to ensure disabled persons and children lead a normal life. They include genetic counseling of persons with disabilities, nutritional care, and ratification of international treaties banning land mines and child safety and injury prevention.
On medical services, the Ministry of Health of KSA has over the last twenty years established hospitals and rehabilitation centres such as King Faisal Specialist Hospital and Research Centre, and the King Khalid Eye Hospital for persons and children with disabilities.
In these facilities, disabled people easily access physical, occupational, speech and hearing therapy to help them cope with their conditions. Additionally, these facilities offer disabled people prosthetic as well as orthotic services (Alexander & Hunter 2004, p. 99).
Education measures for person and children with disability date back to the 1970’s (Marchant & Martyn 1999, p. 32). The ministry of education is charged with the responsibility of managing institutions catering for children with disabilities.
Educational institutions such as the Noor Institute for the Blind, Amal Institute for the Deaf and the Institute for the Mentally Retarded are managed by the ministry of education and help in offering educational rehabilitation of children with disabilities. Additionally there is The Noor Institute for the Blind which has 10 centers, 264 staff and serves 625 visually impaired children.
There is also the Amal Institute for the Deaf that has 23 branches with additional units in certain public schools, approximately 3,000 students of both genders with hearing impairments and 606 qualified teachers (Alghazo, et al 2000, p. 78).
In addition to the above measures, the kingdom had rolled out numerous social measures that are meant to help people and children with disability (Putnam 2007, p. 43). They include inclusion of special, parking places at various institutions, artificial limbs and for people who need them and a subsidy of SR 10000 for all cab owners who modify their cars to accommodate people with special needs (JICA 2002, p. 24).
Moreover, the authorities have advanced education opportunities as part of the social programs. They include opportunities for persons with visual, hearing and speech problems as well as those with intellectual disabilities to receive special education overseen by the Ministry of Education and General Presidency for Girls’ Education (Teebi 2010, p. 26).
Under the social program, there is also an aid program from the Ministry of Labour and Social Affairs that advances an annual allowance of SR 10,000 for every paralyzed child. Persons and children catered for by their own families receive an annual allowance of SR 10, 000 (JICA 2002, p. 21).
The ministry of labour and social affairs also runs social rehabilitation centres that provide shelter and full board lodging to people and children with severe disabilities, multiple disabilities and severe intellectual disabilities. There are also polio care centres, day care centres and social education institutes all of which accommodate children with disabilities for rehabilitation and treatment (Ibrahim et al. 2006, p. 88).
It’s important to note that all the above measures are distributed in many parts of KSA including Jeddah. The policies that governorates and local authorities have formulated regarding care of disabled children are done so with guidance from national policies as directed by the ministries in charge (Shakespeare 2006, p. 58).
Furthermore, most of the policies tackled refer generally to persons with disabilities. As emphasized earlier, these terms are all encompassing thus in most cases it includes children. Disabled children benefit most from health and education and social policies hence the emphasis given to them (Abbott et al. 2000, p. 39).
Methodology
To examine the care policies of KSA, Jeddah, the study conducted semi structured interviews with senior management personnel at the Ministry of Labour and Social Affairs of KSA. All the interviewees are based in KSA and have wide knowledge on the care policies of disabled persons and children. There are many reasons why interviews are preferred by researchers (Craig 2010, p. 78).
First, given the sensitivity of the information that was to be collected for the study and the bureaucracy and secrecy that characterize such official government data, many government personnel in KSA were reluctant to filling questionnaires. Many felt they were making a commitment and that they would easily be unmasked if anything became of the data collected.
As such, they were bound to hold some vital information that was crucial to the study. They were however comfortable with interviews because of the anonymity associated with it. Secondly, it was difficult to select a random sample of willing management personnel given the small size of the departments dealing with disability issues and the sparse distribution of the facilities and offices.
Third, researchers felt interviews were most suitable for the study due to their flexible structured nature. Unlike structured surveys like questionnaires, interviews are flexible and they allowed researchers to impromptly probe the interviewees on the issues that rose in the course of the interview.
This particular factor came in handy when doing follow up questions on the topic and when making recommendations on the way forward in KSA disability policy. Fourth, interviews provided a lot of information that can be used as a basis for future research, development of hypotheses and questionnaires.
Additionally, interviews were critical in the deep probing of the interviewees thanks to the open minded atmosphere that they created and the use of a standardized questionnaire that allowed for commonality and unrestricted discussions.
The interviews were conducted in a manner consistent with a replication logic that is popular in international research. The interviews were structured around the deliverables of care policies of disabled children in Saudi Arabia and Jeddah.
The use of deliverables is consistent with the replication logic that will use the information gathered elsewhere to compare the models of care policies of disabled children between Jeddah Saudi Arabia and Egypt as well as the Emirates.
The referent model that was built through the interviews was that of Jeddah and was used for subsequent comparison. Additionally, the referent model was useful in the identification of key issues as well as additional clues on how it can be applied in the other areas mentioned above.
The interviews were conducted on three senior employees of the ministry of social affairs in the caliber of managers and who are in a position to comment authoritatively on the care policies of disabled children.
The researcher at first discussed the disabled children care policy and asked each of the interviewees to assess the situation in Jeddah and the larger Saudi Arabia within the provided context. Each interview with the managers was conducted separately. At every interview the interviewee was presented with the referent model as well as the one given in the previous interviews.
The information was supplied for confirmation and accuracy purposes. Additionally, the framework used was updated in cases where the researchers felt were necessary.
After the interviews, there were follow up questions that were asked through telephone, e-mail and chat through Skype for those that had access to the internet. This pattern was followed consistently over the course of the interviews ensuring the development of a uniform picture of care policies of disabled children in Saudi Arabia that meets the deliverables set earlier on.
The interviews were conducted using a protocol totaling fifteen questions. It also included numerous follow up questions for purposes of clarity especially where the researchers felt the information was vague. The initial fifteen questions were based on the three areas of analysis that had guided the setting of deliverables.
The questions sough to probe the manager’s views and position on the current disabled children care policy, its strengths, weaknesses and what they felt should be improved. Furthermore the questions required a personal opinion of the managers on the current policies about disabled children in Saudi Arabia and how it compared with peer countries such as Egypt and United Arab Emirates.
The information and views provided by each interviewee formed the basis of comparison between what is currently known about care policies of disabled children in Saudi Arabia.
There was an incremental adoption of disabled care policies and how they were implemented in Saudi Arabia based on the information provided by the interviewees. Additionally, after every interview, the researchers reviewed notes to identify the indicators of policy deliverables that had been identified.
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