Perceptions and experiences of access to public healthcare by people with disabilities and older people in Uganda

Abstract

IntroductionIn the year 2000, a set of eight Millennium Development Goals (MDGs) were presented as a way to channel global efforts into the reduction of poverty and the promotion of social development. A global discussion regarding how to renew these goals is underway and it is in this context that the Goals and Governance for Global Health (Go4Health) research consortium conducted consultations with marginalized communities in Asia, Latin America, the Pacific and Africa as a way to include their voices in world’s new development agenda. The goal of this paper is to present the findings of the consultations carried out in Uganda with two groups within low-resource settings: older people and people living with disabilities.MethodsThis qualitative study used focus group discussions and key informant interviews with older people in Uganda’s Kamwenge district, and with persons with disabilities from the Gulu region. Thematic analysis was performed and emerging categories and themes identified and presented in the findings.FindingsOur findings show that a sense of community marginalization is present within both older persons and persons living with disabilities. These groups report experiencing political sidelining, discrimination and inequitable access to health services. This is seen as the key reason for their poor health. Clinical services were found to be of low quality with little or no access to facilities, trained personnel, and drugs and there are no rehabilitative or mental health services available.ConclusionUganda must fulfil its international obligations and take progressive measures to meet the right to health for all its peoples, but especially allocate its limited resources to proactively support its most marginalized citizens. The growing impetus within post-2015 development negotiations to redress in-country health and other inequalities through a comprehensive systems approach is of importance in the Ugandan development context. This approach reflects the participant’s perspectives, which also calls for a more equitable approach to health and development as opposed to a narrow, vertical focus on specific population groups, as was the case with the MDGs.

Prevalence of Functional Difficulties

“…More broadly, results in Fig. 4.4 suggest that rehabilitation needs are large in Africa and are rarely fulfilled in a healthcare setting (Mulumba et al 2014). No significant gender difference is found in the extent to which individuals took any measure to curb functional difficulties, 7 which is different from results in May-Teerink (1999) for Uganda.…”

Disability, Health and Human Development

“…More broadly, results in Fig. 4.4 suggest that rehabilitation needs are large in Africa and are rarely fulfilled in a healthcare setting (Mulumba et al 2014). No significant gender difference is found in the extent to which individuals took any measure to curb functional difficulties, 7 which is different from results in May-Teerink (1999) for Uganda. This result is consistent with earlier research in Africa and in lowincome settings in general.…”

The World We Want, leaving no one behind: did the Go4Health project represent the voices of marginalised communities into the post-2015 global health discourse?

“…They report that people feel a strong sense of personal responsibility in ensuring their health needs are met, and these meant ensuring that family members have enough to eat, put hygiene practices to use, having adequate sanitation facilities, and seeking health care services when necessary. Family and community as a focus for health are a highlight of the publications (Baba et al, 2014;Mulumba et al, 2014). The failure to have needs met is attributed largely due to state apathy toward marginal groups, and at other times, due to active discrimination and structural violence, as in the cases of Guatemala and Bangladesh, where the state has forced indigenous communities to leave their original homelands (Baba, Brolan, and Hill 2014;Mulumba et al 2014;.…”

“…Family and community as a focus for health are a highlight of the publications (Baba et al, 2014;Mulumba et al, 2014). The failure to have needs met is attributed largely due to state apathy toward marginal groups, and at other times, due to active discrimination and structural violence, as in the cases of Guatemala and Bangladesh, where the state has forced indigenous communities to leave their original homelands (Baba, Brolan, and Hill 2014;Mulumba et al 2014;. That discrimination is a deep-rooted structural barrier for health is clear-it prevents people from accessing care because of the anticipated ill treatment by health care providers as reported in Baba's research (2014).…”

“…The uniqueness of each of WP2's community consultations lent an extraordinary diversity to Go4Health's output, which informed the mandate for global health while also making important contributions to wider policy discourse around the SDGs (Ibell et al 2015;Hussain 2014;Brolan et al 2014;Sheridan et al 2014;Baba, Brolan, and Hill 2014;Mulumba et al 2014 I conducted research in communities in 3 countries on behalf of BRACU: Afghanistan, Bangladesh, and the Philippines. My site selections were based on the guidance of both the Go4Health protocol as well as those of my BRACU supervisory reference group.…”