DISQOL'e dön

TAXONOMY OF CARE TO DISABLED PEOPLE IN TURKEY

TAXONOMY OF CARE TO DISABLED PEOPLE IN TURKEY

Prof. Dr. Erhan Eser

PI of Izmir DISQOL centre

e.eser@bayar.edu.tr

eseres@ttnet.net.tr

 BRIEF DESCRIPTION OF CARE SITUATION IN TURKEY :

 In the abstract of the Secondary Analysis of Disability Survey of Turkey, 2002 (published in January 2006, www.ozida.gov.tr ) it was stated that “ In the context of the Secondary Analysis of Disability Survey of Turkey, 2002, three main issues were dealt with which were services provided to disabled, usage of these services by the disabled and service opportunities to the disabled. Under these three main topics the report particularly addressed the following issues: education, vocational training, social security, income, care and rehabilitation of the disabled. Findings indicate the existence of a disabled group who were low educated, lacked social security coverage and had low income. Report provides clues to administrators and experts working in the field in order to reduce the factors who contribute to the isolation of the disabled from society and eventually to wipe them off altogether and to provide equal opportunities to the disabled regardless of age, sex, social status.”

The prevalence of disability in Turkey was estimated as 12.89 based on the criteria of ICF by Turkey Disability Survey of Turkey 2002. There a number of state, private and volunteer (NGO) organizations that give care services to disabled people in Turkey . Prime Minister Administration for Disabled People ( http://www.ozida.gov.tr ) is one of the leading state institutions. Social Services and Child Protection, Ministry of Health, Ministry of Finance, Ministry of Public Works and Settlement, Prime Ministry Under-secretariat of Customs and Municipalities are the other state organizations that were involved in the services given to the disabled people in the country. In addition to the state bodies, there are numerous foundations and Societies working directly or indirectly in this area. Care centres for disabled people are one of the most scarce health and social care units of the country.

The administrative bodies for Disability in Turkey can be first divided into two main classes: 1. Government run , 2. Private or NGO run bodies.

1. The administrative bodies run by the Government :

a- Prime Minister Administration for Disabled People

b- Deputy State Minister, Social Services and Child Protection, Ministry of Health

c- Ministry for Internal Affairs, Martyr and Veteran Division

The organizational Schedule of these administrative bodies is illustrated below:

2. The administrative bodies run by Private or Non-Governmental non-profit institutions

a- Foundations (n=43)

b- Confederations which give services to the Disabled people in Turkey

Turkish Labour Union Confederation

Turkish Employers’ Union Confederation

Turkish Confederation of Disabled People

c-Federations

Turkish Physical Disability and Sports Federation

Turkish Vision Disability Federation

Turkish Vision Disability and Sports Federation

Turkish Mental Disability Federation

Turkish Mental Disability Sports Federation

Turkish Orthopaedic Disability Federation

Turkish Spastic Disability Federation

d- Sports Clubs for Disabled People

Wheel Chair Basketball Clubs (n=47)

Hearing Disabled Sport Clubs (n=87)

Vision Disabled Sport Clubs (n=45)

Mental Disabled Sport Clubs (n=81)

Special Laws and Regulations for Disabled People in Turkey :

There are 43 Laws and 38 Regulations have been operated in Turkey dealing with Disabled and disability in Turkey . The recent one is “Law for Disabled People. Dated: 07.07.2005 , no: 5378” which gives wide variety of advantages to disabled peopled compared to past.

Some legal advantages given to the disabled persons and their families in Turkey can be briefly listed as :

  • The right of tax exemption to the disabled people and their families who care them (income tax, real estate tax, customs tax and luxury consumption tax immunities in changing percentages, up to 80% according to the severity of the disability)
  • Monthly regular payment of minimum legal wage to the families or relatives who care disabled people
  • The right of free out-patient health services excluding medicines and free institutional health care including medicines for disabled people.
  • Tax immunisation for special support devices (wheel chairs, bicycle) and motor vehicles (cars <1600 cc engine) for disabled people
  • The right of getting “Disabled Identification Card” in case of more that 40% loss of capability.
  • The right of getting free education and rehabilitation services in special disabled classes and centres even supplied by Private institutions (Government pay full charge to the private schools and rehabilitation centres for disabled people)
  • The legal quota for the employers to employ at least 3% disabled employers both for government and private enterprises.

There are 572 rehabilitation centres authorised by the State department of Social Services and Child Protection in which 500 of them are private run care centres (47 centres for hearing-speech disabled; 444 centres for learning disabled and 9 for Spastic patients). There are 35 over-night stay (boarding) centres run by State department of Social Services and Child Protection. 2474 overnight and 2033 day care services has given to 4507 disabled people in these institutions. However, 4317 (2000 children) are waiting to be accepted to these care centres in the country. In addition to these centres, there are 27 Physical Therapy and Rehabilitation centres with a bed capacity of 1987 beds run by Ministry of Health and State Army. When we look at the services given to elderly, there are 195 older adults nursing (boarding) centres in which 66 were run by state institutions. These centres serve 19 139 disabled persons and older adults in total. Among these 33 % receive continuous rehabilitation care in these centres. A need of 258 care centre with a capacity of 100 beds per centre was estimated in recent (2002) National Disability study. One of the most important development in the country is the adoption of “Law on disabled people and on making amendments in some laws and decree laws (Law No : 5378)”. Article 1of this law states the objective of this law as: “.. to prevent disability, to enable the disabled people to join the society by taking measures which will provide the solution of their problems regarding health, education, rehabilitation, employment, care and social security and the removal of the obstacles they face and to make the necessary arrangements for the coordination of these services”. On the other hand a Disability Action Plan prepared for the years between 2005 and 2010 includes provision of solutions for primary problems faced by disabled people to the extent of our country’s. One of the first and the foremost objective of this plan is to provide the empty vacancies to be filled in the frame of quota requirement both in public and private sector, and the 2005 was announced as the “Employment Year for Disabled People” by the suggestion of State Minister.

1- Living Situation of Disabled Population:

About 98% of the disabled people are cared by their families or relatives. Currently, professional home care service is a very newly emerging private service area that can easily be negligible in Turkey . Very few attempts are done by some municipalities and non-profit foundations and societies by means of some pilot trials. Only 0.3% of the disabled population take institutional care. 19 139 disabled persons and older adults receive continuous institutional care in the centres run by State department of Social Services and Child Protection. However in official figures, 3639 disabled people are waiting to be accepted to the institutional care in the country. Nevertheless it should be stated here that those whose parents were died; those in a very derivate condition; whose parents are very severely physically or mentally retarded; those who have multiple disabilities are accepted immediately to these institutional care regardless to await his/her turn.

2-Care Provider:

As it was stated above almost 98% of the disabled people receive non-paid home care by their family or relatives. The rest of the disabled people have been cared by the Professional staff of state institutions which are mostly nurses and social workers and physical therapists.

3-Care & Support:

It was found that 58.9 % of the disabled people can live independently. The care of the bed-dependent disabled persons could be done mostly at home or periodically (with short periods) in the state hospitals. Detailed data for those who live with partner, family, friend, paid care, animal support and technical equipments are absent.

According to the recent disability survey 2002, 5.9% of the disabled people have access to care and rehabilitations services in the country, in which almost all were run by government.

Of the 72 care centres run by State department of Social Services and Child Protection, 35 care centres which are specialized with diverse type of disability give continuous over-night care to the disabled persons in Turkey . The rest of the centres are only day-care centres .

According to the 2006 data, there are 1006 staff (health services, social services, technical services, administration and axially staff) working in the care and rehabilitation centres run by State department of Social Services and Child Protection. Health services have been carried out by medical doctors, nurses, social workers, dentists, psychologists, physical therapists, pedagogues, dieticians and psychological guiding staff with a number of 368 country-wide. In addition to this, 81 specially skilled teacher are working in these care centres. On the other hand there a considerable amount of staff are employed in the private care centres. According to the legal regulations, each private centre has to employ at least one medical doctor, social worker, specially skilled teacher or pedagogues, physical therapist, psychologist and psychological guiding staff, but the number of them can not be estimated at the moment.

When we look at the reasons of inaccessibility to the care and support services in the community, disabled persons stated the reason as: Financial restrictions (57.3%), geographical inaccessibility (long distance) (11.9%), do not know the opportunities (6.6%), the problem was solved in the family environment (6.4%), the disabled person is young to get those services (6.35), they do not believe that they would benefit from the services (3.3%) and they stated that they asked service but they were refused by the authorities (2.3%).

4-Physical Environment:

 

The person (bed) capacity of 38 over-night centres are: 36.8% (n=14) of the centres with a capacity of 20-49 persons ; 47.4% (n=18) of the centres with a capacity of 50-99 persons ; 15.8% (n=6) of the centres with a capacity of 100 and over persons. The capacity of the day care centres could not be determined .

%83.3 of the Government run Care and Rehabilitation centres are localised in urban settlements while 16.7% are localised in semi-urban (counties) areas. On the other hand 88.0% of the Private care centres are in urban districts.

5-Community Integration:

 

Physical and ergonomic infrastructures are still very poor in the country. Nevertheless the recent Law commands to modify infrastructure (elevators, special toilets, platforms for public busses) for disabled people in the Government and Municipality buildings, schools and vehicles. According to the recent disability survey 2002, only 5.0% of the disabled people stated that they have the accessibility to the public transportation and only 3.0% stated that their physical environment (streets, buildings) are specially designed for the disabled persons.

In addition to the 269 Special education and rehabilitation classes served by 16 155 skilled teachers, there are a considerable number of mixed classes for the integration of disabled and non-disabled children but mostly localised in metropolitan cities. As for the education status of the disabled population, it was found that the illiteracy rate was 36.3% for the entire disabled population whereas it was 66.9 for mentally disabled population in Turkey .

An another aspect of social community integration is the legal quota for the employers to employ at least 3% disabled employers both for government and private enterprises.

As an indicator of social inclusion, only 2.5 % of the disabled people stated that they are (or their families) a member of disabled societies or foundations.

 

6-Care Characteristics:

The care model and focus for disabled people in Turkey –until recently- is based of home care and segregated institutional care. But recent legal developments might give the opportunity for community integrated care in the schools, work places and other public places in addition to the growing support to the home care which would strengthen community integration of the disabled people itself.

7-Employment / Occupation:

The work-force participation of the disabled population in Turkey is 21.7% according to the 2002 Disability survey. But only very few (about 1%) received vocational skills education or courses. The recent data indicates that 4.3% of the disabled population is student, 19.5 is house wife, 8.5% is retired, 15.5 is unemployed . The status of the remaining 30.5% is unknown.

8-Rehabilitation:

Rehabilitation services have given in 27 Ministry of Heath and Military Health services with a bed capacity of 1987 beds in Turkey . 2002 survey data indicated that only 5.9 % of the disabled population have access to the rehabilitation services in the country. The Physical therapy departments of the University hospitals can be added to these centres as well.

In regard to social rehabilitation services, State department of Social Services and Child Protection carry some population Project which include art and sport activities towards disabled population together with numerous NGO’s and municipalities in the country. We can add new emerging vocational training courses –that were mentioned above- to this sub- title as well. A recent nation-wide Project titled “Turkey, Free of Disability” which is carried out by State department of Social Services and Child Protection have a special focus on increasing the awareness of the disabled persons in the community on their legal rights that would facilitate their use of social and medical rehabilitation services.

 

9-Other Clinical &

Therapy Services:

Except the Physical Therapy and Rehabilitation Clinics and departments of the State Hospitals and University hospitals, there is a big unmet need for medical rehabilitation services in the country. Although there exists a well organized population based Primary Health Care system in the country, Rehabilitation services are out of scope in these PHC centre which were organized on Mother and Child care problems as a primary priority. In another words, the present PHC system needs a modification towards solving chronic and disabling health problems.

 

10-Funding Arrangements

 

As it was stated above under relevant titles of this report, legal regulations is very promising in regard to the financial support to the disabled population in Turkey . As in the most community health issues, an important unawareness problem exists in Turkey among disabled population and their families. These problems might be gradually solved by increasing community participation. As we know only 2.5% of the disabled population and their families are members of societies in Turkey . Obviously this figure indicated the poor community participation in solving the problems of the disabled population in the country.

community participation in solving the problems of the disabled population in the country.