Suggested solutions to barriers in accessing healthcare by persons with disability in Uganda: a qualitative study.
Healthcare access
Persons with disabilities
Qualitative
Recommendations
Solutions
Uganda
Journal
BMC health services research
ISSN: 1472-6963
Titre abrégé: BMC Health Serv Res
Pays: England
ID NLM: 101088677
Informations de publication
Date de publication:
31 Aug 2024
31 Aug 2024
Historique:
received:
29
05
2024
accepted:
16
08
2024
medline:
1
9
2024
pubmed:
1
9
2024
entrez:
31
8
2024
Statut:
epublish
Résumé
There are 1.3 billion people with disabilities globally, and they frequently face barriers to accessing healthcare, contributing to their worse health and higher mortality. However, little research has explored patient-reported approaches to improve healthcare for persons with disabilities. Consequently, this study aimed to explore possible solutions and recommendations to address the existing barriers to access to healthcare for persons with disabilities in rural Uganda. We conducted 27 semi-structured interviews with individuals with various disabilities in rural Luuka district, Eastern Uganda, between September and November 2022. The participants included individuals with visual impairment (n = 5), physical impairment (n = 5), hearing impairment (n = 6), multiple impairments (n = 5), intellectual/cognitive impairment (n = 5), and albinism (n = 1). Interviews were recorded, transcribed verbatim, and thematically analysed. We categorized the solutions using the Missing Billion disability-inclusive health systems framework. Our findings, framed within the health systems framework, revealed several critical themes. On the demand side, suggested solutions emphasized advocacy and sensitization for persons with disabilities, their communities, and caregivers about healthcare needs. Socio-economic empowerment and community-based health services were also highlighted as essential. On the supply side, participants stressed the importance of training healthcare workers on disability, facilitating dialogue and experience-sharing sessions, and employing health workers with disabilities. Additional recommendations included improving accessibility and reasonable accommodation, organizing inclusive services like special clinic days and outreaches, ensuring representation in health facility management, and establishing comprehensive rehabilitation services with affordable assistive devices. The multifaceted solutions proposed by persons with disabilities highlight the complex challenges they face in accessing healthcare services and highlight the necessity for comprehensive, sustainable interventions. The call to action for policymakers and healthcare providers is to prioritise the incorporation of disability-inclusive practices and explore multi-dimensional approaches that foster a more inclusive healthcare environment that adequately meets the needs of persons with disabilities.
Sections du résumé
BACKGROUND
BACKGROUND
There are 1.3 billion people with disabilities globally, and they frequently face barriers to accessing healthcare, contributing to their worse health and higher mortality. However, little research has explored patient-reported approaches to improve healthcare for persons with disabilities. Consequently, this study aimed to explore possible solutions and recommendations to address the existing barriers to access to healthcare for persons with disabilities in rural Uganda.
METHODS
METHODS
We conducted 27 semi-structured interviews with individuals with various disabilities in rural Luuka district, Eastern Uganda, between September and November 2022. The participants included individuals with visual impairment (n = 5), physical impairment (n = 5), hearing impairment (n = 6), multiple impairments (n = 5), intellectual/cognitive impairment (n = 5), and albinism (n = 1). Interviews were recorded, transcribed verbatim, and thematically analysed. We categorized the solutions using the Missing Billion disability-inclusive health systems framework.
RESULTS
RESULTS
Our findings, framed within the health systems framework, revealed several critical themes. On the demand side, suggested solutions emphasized advocacy and sensitization for persons with disabilities, their communities, and caregivers about healthcare needs. Socio-economic empowerment and community-based health services were also highlighted as essential. On the supply side, participants stressed the importance of training healthcare workers on disability, facilitating dialogue and experience-sharing sessions, and employing health workers with disabilities. Additional recommendations included improving accessibility and reasonable accommodation, organizing inclusive services like special clinic days and outreaches, ensuring representation in health facility management, and establishing comprehensive rehabilitation services with affordable assistive devices.
CONCLUSION
CONCLUSIONS
The multifaceted solutions proposed by persons with disabilities highlight the complex challenges they face in accessing healthcare services and highlight the necessity for comprehensive, sustainable interventions. The call to action for policymakers and healthcare providers is to prioritise the incorporation of disability-inclusive practices and explore multi-dimensional approaches that foster a more inclusive healthcare environment that adequately meets the needs of persons with disabilities.
Identifiants
pubmed: 39217300
doi: 10.1186/s12913-024-11448-4
pii: 10.1186/s12913-024-11448-4
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
1010Subventions
Organisme : National Institute for Health and Care Research
ID : NIHR301621
Informations de copyright
© 2024. The Author(s).
Références
World Health Organization. Tracking universal health coverage. Geneva: World Health Organisation; 2015.
Nunes R, Nunes SB, Rego G. Health care as a universal right. Z Gesundh Wiss. 2017;25(1):1–9.
doi: 10.1007/s10389-016-0762-3
pubmed: 28133598
Hashemi G, Wickenden M, Bright T, Kuper H. Barriers to accessing primary healthcare services for people with disabilities in low and middle-income countries, a Meta-synthesis of qualitative studies. Disabil Rehabil. 2022;44(8):1207–20.
doi: 10.1080/09638288.2020.1817984
pubmed: 32956610
Kuper H, Hanefeld J. Debate: can we achieve universal health coverage without a focus on disability? BMC Health Serv Res. 2018;18(1):738.
doi: 10.1186/s12913-018-3547-2
pubmed: 30257668
pmcid: 6158923
The Lancet. Prioritising disability in universal health coverage. Lancet. 2019;394(10194):187.
doi: 10.1016/S0140-6736(19)31638-1
pubmed: 31327349
Soltani S, Takian A, Akbari Sari A, Majdzadeh R, Kamali M. Financial Barriers to Access to Health Services for Adult People with disability in Iran: the challenges for Universal Health Coverage. Iran J Public Health. 2019;48(3):508–15.
pubmed: 31223579
pmcid: 6570792
World Health Organization. Global report on health equity for persons with disabilities. Geneva: World Health Organization,; 2022.
The Lancet Public Health. Disability-a neglected issue in public health. Lancet Public Health. 2021;6(6):e346.
doi: 10.1016/S2468-2667(21)00109-2
pubmed: 34051158
Kaur G, Prinja S, Lakshmi PVM, Downey L, Sharma D, Teerawattananon Y. Criteria used for Priority-setting for Public Health Resource Allocation in Low- and Middle-Income countries: a systematic review. Int J Technol Assess Health Care. 2019;35(6):474–83.
doi: 10.1017/S0266462319000473
pubmed: 31307561
Lane H, Sarkies M, Martin J, Haines T. Equity in healthcare resource allocation decision making: a systematic review. Soc Sci Med. 2017;175:11–27.
doi: 10.1016/j.socscimed.2016.12.012
pubmed: 28043036
Gudlavalleti VSM. Challenges in Accessing Health Care for people with disability in the south Asian context: a review. Int J Environ Res Public Health. 2018;15(11):2366.
doi: 10.3390/ijerph15112366
pubmed: 30373102
pmcid: 6265903
Eide AH, Mannan H, Khogali M, van Rooy G, Swartz L, Munthali A, et al. Perceived Barriers for Accessing Health Services among individuals with disability in four African countries. PLoS ONE. 2015;10(5):e0125915.
doi: 10.1371/journal.pone.0125915
pubmed: 25993307
pmcid: 4489521
Smythe T, Mabhena T, Murahwi S, Kujinga T, Kuper H, Rusakaniko S. A path toward disability-inclusive health in Zimbabwe Part 2: a qualitative study on the national response to COVID-19. Afr J Disabil. 2022;11:991.
pubmed: 35747759
pmcid: 9210124
Peterson-Besse JJ, Walsh ES, Horner-Johnson W, Goode TD, Wheeler B. Barriers to health care among people with disabilities who are members of underserved racial/ethnic groups: a scoping review of the literature. Med Care. 2014;52(10 Suppl 3):S51–63.
doi: 10.1097/MLR.0000000000000195
pubmed: 25215920
Della Fina V, Cera R, Palmisano G. The United Nations convention on the rights of persons with disabilities: a commentary. Springer; 2017.
Saran A, White H, Kuper H. Evidence and gap map of studies assessing the effectiveness of interventions for people with disabilities in low-and middle-income countries. Campbell Syst Rev. 2020;16(1):e1070.
doi: 10.1002/cl2.1070
pubmed: 37131970
pmcid: 8356326
Dassah E, Aldersey HM, McColl MA, Davison C. Health care providers’ and persons with disabilities’ recommendations for improving access to primary health care services in rural northern Ghana: a qualitative study. PLoS ONE. 2022;17(9):e0274163.
doi: 10.1371/journal.pone.0274163
pubmed: 36112654
pmcid: 9481012
McClintock HF, Kurichi JE, Barg FK, Krueger A, Colletti PM, Wearing KA, et al. Health care access and quality for persons with disability: patient and provider recommendations. Disabil Health J. 2018;11(3):382–9.
doi: 10.1016/j.dhjo.2017.12.010
pubmed: 29325927
Brown AF, Ma GX, Miranda J, Eng E, Castille D, Brockie T, et al. Structural Interventions to Reduce and Eliminate Health Disparities. Am J Public Health. 2019;109(S1):S72–8.
doi: 10.2105/AJPH.2018.304844
pubmed: 30699019
pmcid: 6356131
The Missing Billion Initiative and Clinton Health Access Initiative. Reimagining health systems that expect, accept and connect 1 billion people with disabilities. 2022.
The Missing Billion Initiative. Compendium of good practice examples to improve health services for people with disabilities 2020–2023: The Missing Billion Initiative. 2024 [ https://www.themissingbillion.org/good-practices
Ministry of Health. Hospitals Kampala: Uganda Ministry of Health. 2024 [ https://www.health.go.ug/hospitals/
Turyamureba M, Yawe B, Oryema JB. Health Care Delivery System in Uganda: a review. Tanzan J Health Res. 2023;24(2):57–64.
Ministry of Health. The Ministry of Health Strategic Plan 2020/21–2024/25 Kampala. Uganda Ministry of Health,; 2021.
Kim J-H, Bell GA, Bitton A, Desai EV, Hirschhorn LR, Makumbi F, et al. Health facility management and primary health care performance in Uganda. BMC Health Serv Res. 2022;22(1):275.
doi: 10.1186/s12913-022-07674-3
pubmed: 35232451
pmcid: 8886189
Kuper H, Ssemata AS, Smythe T, Drazdzewska J, Waiswa P, Kagurusi P, et al. Is it feasible to implement a community-based participatory group programme to address issues of access to healthcare for people with disabilities in Luuka district Uganda? A study protocol for a mixed-methods pilot study. BMJ Open. 2023;13(9):e074217.
doi: 10.1136/bmjopen-2023-074217
pubmed: 37770271
pmcid: 10546107
UNICEF. Inclusion of children and young people with disabilities in routine general health care. A practice guide. Norway: Norway-UNICEF Disability Partnership Framework; 2022. August 2022.
Mijumbi-Deve R, Kawooya I, Nankya E, Sewankambo N. Primary health care systems (PRIMASYS): case study from Uganda. Geneva: World Health Organization; 2017.
The World Bank. Population total - Uganda, Washington DC. The World Bank,; 2022 [ https://data.worldbank.org/indicator/SP.POP.TOTL?locations=UG
World Health Organization. Uganda - Country cooperation strategy Geneva, Switzerland: World Health Organization. 2018 [ https://apps.who.int/iris/bitstream/handle/10665/136975/ccsbrief_uga_en.pdf
Harrison JAK, Thomson R, Banda HT, Mbera GB, Gregorius S, Stenberg B, et al. Access to health care for people with disabilities in rural Malawi: what are the barriers? BMC Public Health. 2020;20(1):833.
doi: 10.1186/s12889-020-08691-9
pubmed: 32487088
pmcid: 7268500
Busetto L, Wick W, Gumbinger C. How to use and assess qualitative research methods. Neurol Res Pract. 2020;2:14.
doi: 10.1186/s42466-020-00059-z
pubmed: 33324920
pmcid: 7650082
Kielmann K. Introduction to qualitative research methodology: a training manual. Norwich: University of East Anglia; 2012. p. NR4.
Tomaszewski LE, Zarestky J, Gonzalez E. Planning qualitative research: design and decision making for New Researchers. Int J Qualitative Methods. 2020;19:1609406920967174.
doi: 10.1177/1609406920967174
Naeem M, Ozuem W, Howell K, Ranfagni S. Demystification and actualisation of data saturation in qualitative research through thematic analysis. Int J Qualitative Methods. 2024;23:16094069241229777.
doi: 10.1177/16094069241229777
Casebolt MT. Barriers to reproductive health services for women with disability in low- and middle-income countries: a review of the literature. Sex Reproductive Healthc. 2020;24:100485.
doi: 10.1016/j.srhc.2020.100485
Schenk KD, Tun W, Sheehy M, Okal J, Kuffour E, Moono G, et al. Even the fowl has feelings: access to HIV information and services among persons with disabilities in Ghana, Uganda, and Zambia. Disabil Rehabil. 2020;42(3):335–48.
doi: 10.1080/09638288.2018.1498138
pubmed: 30282493
Benz C, Scott-Jeffs W, McKercher KA, Welsh M, Norman R, Hendrie D, et al. Community-based participatory-research through co-design: supporting collaboration from all sides of disability. Res Involv Engagem. 2024;10(1):47.
doi: 10.1186/s40900-024-00573-3
pubmed: 38730283
pmcid: 11084036
Kuper H, Hameed S, Reichenberger V, Scherer N, Wilbur J, Zuurmond M et al. Participatory Research in disability in low- and Middle-Income countries: what have we Learnt and what should we do? Scandinavian J Disabil Res. 2021.