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 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 CommunityHealth (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.health and lack of it may be both an indicator and "contributory cause" [1] of a population's healthinequalities. An array of diverse barriers, occurring at various points along the pathways to care, restricts health care accessibility for many individuals and groups globally. Especially disproportionate though, is the extent and impact of the barriers encountered by the world's largest minority group:It is estimated that over one billion of the global population are disabled in some way and, with this figure on the rise, the World Health Organisation (WHO) has declared a need for more qualitative research in order to better understand the "lived experiences of people with disabilities" [2]. A recent systematic review [3] highlights an especially "urgent" requirement for research in low-and middlein...

Conceptual Model of Hearing Health Inequalities (HHI Model): A Critical Interpretive Synthesis

“…In contrast, the same individual with ample financial resources may feel able to prioritize their health needs (Barnett et al., 2014). Therefore, having a low SEP may not only be a barrier to accessing hearing health care due to financial costs (Barnett et al., 2014), but it may also reflect disparities in people’s access to identification and treatment of hearing problems (Chan et al., 2017; Harrison et al., 2020; Luo et al., 2020). The latter is discussed in Benova et al.’s (2015) study, which examines four SEP indicators—education, occupation, income, wealth—in the health-seeking process of older adults with hearing loss.…”