Access barriers to medical facilities for people with physical disabilities: the case of Peru

Abstract

People with disabilities (PWD) face several challenges accessing medical services. However, the extent to which architectural and transportation barriers impede access to healthcare is unknown. In Peru, despite laws requiring that buildings be accessible for PWD, no report confirms that medical facilities comply with such regulations. Thus, we aim to provide an association between these barriers and access to medical facilities. Data from a Peruvian disability survey were analyzed. Participants were 18 years of age and older people who reported having a physical disability. Accessibility was defined by reported struggles accessing medical facilities (health or rehabilitation centers). Absence of ramps, handrails, elevators, adapted bathrooms, and information counters in medical facilities were reported as architectural barriers. The transportation barriers analyzed included struggles using buses or trains. Poisson regression models with robust variance were used to estimate prevalence ratios (PR) and to control for confounding variables. 20,663 participants were included, their mean age was 66.5 years and 57.5% were females. Architectural and transportation barriers reported were 40% and 61%, respectively. All barriers reported were more prevalent in rural compared to urban areas (p < 0.001). Inadequacy of ramps, handrails, and adapted elevators and bathrooms were associated with limited use of rehabilitation centers (p < 0.001) but not of health centers (p > 0.05). Architectural and transportation barriers represent a hindrance to seeking treatment at rehabilitation centers. Actions to improve this situation are needed.

Factors associated with home birth in Peru: An analysis of the Demographic and Health Survey, 2019

“…It was found that those regions that are part of the Peruvian amazon and Andes are more likely to present cases of home births, which matches with a similar study that had the same geographical area (19). It should be noted that these regions are characterized by sociodemographic hurdle, which leads to the inaccessibility of health services (20)(21)(22). According to many authors, other reasons why women in the Peruvian Amazon prefer to have a home birth is the cultural pattern and the lack of cohesiveness with health facilities (23), which is why it is suggested to continue promoting the adequacy of intercultural delivery.…”

Healthcare Barriers Among Working-Age Persons with Disabilities in Trinidad

“…Persons with disabilities identified various barriers spanning the personal, healthcare facility and societal levels. These included personal, familial, and staff attitudes, financial strain, incompetence among healthcare professionals, inaccessibility of governmental grants, and a lack of resources and services at facilities (Alborz et al, 2005; Howard & Rhule, 2021; Moscoso-Porras et al, 2019; Munthali et al, 2019; Parey, 2021a, 2021b; VanPuymbrouck et al, 2020; Vergunst et al, 2015). Although most of the identified barriers exist in the literature including in the localised context for older persons with disabilities and children with disabilities, newly identified barriers among working-age persons with disabilities in Trinidad relate to the absence of a digitalised healthcare system, the prioritization of work, attitudes among public transportation drivers, and safety issues arising from the navigation of public spaces.…”

“…Persons with disabilities engaged in self-medication (Munthali et al, 2019) and relatives’ willingness to support them was based on misperceptions of the urgency and severity of the issue (Alborz et al, 2005). Regarding environmental barriers, the issue went beyond physical access (Parey, 2020a) with the literature reporting on uneven pathways, narrow doorways, inadequate bathroom facilities, the absence of appropriate signage, inadequate medical equipment, and insufficient communication mechanisms for people with sensory disabilities (Iezzoni, 2011; Jeamwatthanachai et al, 2019; Moscoso-Porras et al, 2019; Munthali et al, 2019; Schniedewind et al, 2020; Vergunst et al, 2015; Withers & Speight, 2017). Long queues at the health facilities (Dassah et al, 2018; Munthali et al, 2019), insufficient legislative and policy frameworks, low funding, and the non-involvement of persons with disabilities in decision-making were also barriers (Krahn et al, 2015; World Health Organization, 2015).…”

“…Long queues at the health facilities (Dassah et al, 2018; Munthali et al, 2019), insufficient legislative and policy frameworks, low funding, and the non-involvement of persons with disabilities in decision-making were also barriers (Krahn et al, 2015; World Health Organization, 2015). The inaccessibility of public transportation and the absence of transportation services through healthcare facilities, especially in rural areas, were barriers which led to financial challenges (Howard & Rhule, 2021; Moscoso-Porras, et al, 2019; Munthali et al, 2019; Soltani et al, 2019; Vergunst et al, 2017). In fact, substantial extra costs are a major concern among persons with disabilities even for healthcare (Mitra et al, 2017; Morris & Zaidi, 2020).…”

Mobility impairment and life satisfaction in the Northern Region of Malawi

“…participating in the labour market, effectively creating a cyclical relationship between disability and poverty (Banks, Kuper & Polack 2017;Ganle et al 2020;Moscoso-Porras, Fuhs & Carbone 2019;Payne, Mkandawire & Kohler 2013;Soltani et al 2019;Trani et al 2018;Yeo & Moore 2003). Many of these downstream effects of living with disability relate to a lack of accessibility -to physical places, opportunities and, more broadly, to inclusion, respect and dignity.…”