Access to health care for people with disabilities in rural Malawi: what are the barriers?
Abstract Background People with disabilities experience significant health inequalities. In Malawi, where most individuals live in low-income rural settings, many of these inequalities are exacerbated by restricted access to health care services. This qualitative study explores the barriers to healt...
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| Format: | Article |
| Language: | English |
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BMC
2020-06-01
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| Series: | BMC Public Health |
| Subjects: | |
| Online Access: | http://link.springer.com/article/10.1186/s12889-020-08691-9 |
| _version_ | 1819169043170459648 |
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| author | Josephine A. K. Harrison Rachael Thomson Hastings T. Banda Grace B. Mbera Stefanie Gregorius Berthe Stenberg Tim Marshall |
| author_facet | Josephine A. K. Harrison Rachael Thomson Hastings T. Banda Grace B. Mbera Stefanie Gregorius Berthe Stenberg Tim Marshall |
| author_sort | Josephine A. K. Harrison |
| collection | DOAJ |
| description | Abstract Background People with disabilities experience significant health inequalities. In Malawi, where most individuals live in low-income rural settings, many of these inequalities are exacerbated by restricted access to health care services. This qualitative study explores the barriers to health care access experienced by individuals with a mobility or sensory impairment, or both, living in rural villages in Dowa district, central Malawi. In addition, the impact of a chronic lung condition, alongside a mobility or sensory impairment, on health care accessibility is explored. Methods Using data from survey responses obtained through the Research for Equity And Community Health (REACH) Trust’s randomised control trial in Malawi, 12 adult participants, with scores of either 3 or 4 in the Washington Group Short Set (WGSS) questions, were recruited. The WGSS questions concern a person’s ability in core functional domains (including seeing, hearing and moving), and a score of 3 indicates ‘a lot of difficulty’ whilst 4 means ‘cannot do at all’. People with cognitive impairments were not included in this study. All who were selected for the study participated in an individual in-depth interview and full recordings of these were then transcribed and translated. Results Through thematic analysis of the transcripts, three main barriers to timely and adequate health care were identified: 1) Cost of transport, drugs and services, 2) Insufficient health care resources, and 3) Dependence on others. Attitudinal factors were explored and, whilst unfavourable health seeking behaviour was found to act as an access barrier for some participants, community and health care workers’ attitudes towards disability were not reported to influence health care accessibility in this study. Conclusions This study finds that health care access for people with disabilities in rural Malawi is hindered by closely interconnected financial, practical and social barriers. There is a clear requirement for policy makers to consider the challenges identified here, and in similar studies, and to address them through improved social security systems and health system infrastructure, including outreach services, in a drive for equitable health care access and provision. |
| first_indexed | 2024-12-22T19:13:13Z |
| format | Article |
| id | doaj.art-c40895d6d96544bdb20eea951fcc8bd8 |
| institution | Directory Open Access Journal |
| issn | 1471-2458 |
| language | English |
| last_indexed | 2024-12-22T19:13:13Z |
| publishDate | 2020-06-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Public Health |
| spelling | doaj.art-c40895d6d96544bdb20eea951fcc8bd82022-12-21T18:15:37ZengBMCBMC Public Health1471-24582020-06-0120111710.1186/s12889-020-08691-9Access to health care for people with disabilities in rural Malawi: what are the barriers?Josephine A. K. Harrison0Rachael Thomson1Hastings T. Banda2Grace B. Mbera3Stefanie Gregorius4Berthe Stenberg5Tim Marshall6Bristol Medical School, University of BristolCollaboration for Applied Health Research & Delivery, Liverpool School of Tropical MedicineResearch for Equity And Community Health (REACH) TrustResearch for Equity And Community Health (REACH) TrustCollaboration for Applied Health Research & Delivery, Liverpool School of Tropical MedicineLHL InternationalSchool for Policy Studies, University of BristolAbstract Background People with disabilities experience significant health inequalities. In Malawi, where most individuals live in low-income rural settings, many of these inequalities are exacerbated by restricted access to health care services. This qualitative study explores the barriers to health care access experienced by individuals with a mobility or sensory impairment, or both, living in rural villages in Dowa district, central Malawi. In addition, the impact of a chronic lung condition, alongside a mobility or sensory impairment, on health care accessibility is explored. Methods Using data from survey responses obtained through the Research for Equity And Community Health (REACH) Trust’s randomised control trial in Malawi, 12 adult participants, with scores of either 3 or 4 in the Washington Group Short Set (WGSS) questions, were recruited. The WGSS questions concern a person’s ability in core functional domains (including seeing, hearing and moving), and a score of 3 indicates ‘a lot of difficulty’ whilst 4 means ‘cannot do at all’. People with cognitive impairments were not included in this study. All who were selected for the study participated in an individual in-depth interview and full recordings of these were then transcribed and translated. Results Through thematic analysis of the transcripts, three main barriers to timely and adequate health care were identified: 1) Cost of transport, drugs and services, 2) Insufficient health care resources, and 3) Dependence on others. Attitudinal factors were explored and, whilst unfavourable health seeking behaviour was found to act as an access barrier for some participants, community and health care workers’ attitudes towards disability were not reported to influence health care accessibility in this study. Conclusions This study finds that health care access for people with disabilities in rural Malawi is hindered by closely interconnected financial, practical and social barriers. There is a clear requirement for policy makers to consider the challenges identified here, and in similar studies, and to address them through improved social security systems and health system infrastructure, including outreach services, in a drive for equitable health care access and provision.http://link.springer.com/article/10.1186/s12889-020-08691-9Health care accessBarriersDisabilityImpairmentMalawiRural |
| spellingShingle | Josephine A. K. Harrison Rachael Thomson Hastings T. Banda Grace B. Mbera Stefanie Gregorius Berthe Stenberg Tim Marshall Access to health care for people with disabilities in rural Malawi: what are the barriers? BMC Public Health Health care access Barriers Disability Impairment Malawi Rural |
| title | Access to health care for people with disabilities in rural Malawi: what are the barriers? |
| title_full | Access to health care for people with disabilities in rural Malawi: what are the barriers? |
| title_fullStr | Access to health care for people with disabilities in rural Malawi: what are the barriers? |
| title_full_unstemmed | Access to health care for people with disabilities in rural Malawi: what are the barriers? |
| title_short | Access to health care for people with disabilities in rural Malawi: what are the barriers? |
| title_sort | access to health care for people with disabilities in rural malawi what are the barriers |
| topic | Health care access Barriers Disability Impairment Malawi Rural |
| url | http://link.springer.com/article/10.1186/s12889-020-08691-9 |
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