Access to Health for Persons with Disabilities: Areas of Concern

Overarching Barriers Faced by Persons with Disabilities in Accessing Health

Challenges to persons with disabilities continue to exist in both developed and developing countries, albeit at varying degrees. These challenges include difficult access to medical care/treatment, therapy, assistive technology, education, neglect, marginalization, exploitation, stigma, humiliation etc.

Although both men and women face barriers to health care, men are less likely than women to consider that they or their children are sick enough to require health care services and to know where to access those services. Men also report more difficulties in accessing health care financing[1] .

The health status of persons with disabilities is often poorer than that of the general population. Until relatively recently such differences were frequently viewed as an inevitable consequence of disability, but it is increasingly recognized that they may actually be the result of inequalities and inequities in access to healthcare.

Problems of disability largely manifest in social contexts and social relations, rather than in an individual’s medical condition. In the context of health, stigma and prejudice give rise to additional barriers that persons with disabilities then face. These include:

 

  • physical barriers that prevent access for persons with disabilities to health clinics and hospitals;
  • informational barriers that prevent access for persons with disabilities to health literacy and information brochures and leaflets on health promotion, prevention and protection;
  • attitudinal barriers which give rise to discrimination that can have severe implications for the rights of persons with disabilities, particularly for those with psychosocial disabilities; and
  • institutional barriers that include legislation, practices and processes that prohibit access to health services for persons with disabilities.

Services for people with physical, sensory or intellectual disabilities have also been the subject of criticism in relation to communication and cultural barriers.

Access to healthcare for persons with disabilities extends well beyond the accessibility factors described above. Differences in access to health and social services may arise due to availability insofar as services may be scarce or simply not be provided to certain groups, quality may vary between groups, and not all groups may be aware of certain services owing to information deficiencies. It is important both to enhance the capacity of persons with disabilities to access the healthcare system and also to ensure that the system is able to respond in an appropriate and timely manner to their needs.

Specialist Services

While ensuring that persons with disabilities have access to general health services, some specialist services, such as rehabilitation services, may be needed. For example, in some cases persons require care or rehabilitation services specific to their impairment. Many countries have a National Rehabilitation Hospital or Centre which provides specialist services to patients from all over the country who, as a result, of accident, illness or injury, have acquired a physical or cognitive disability and require specialist rehabilitation.

The difficulty in many countries is that such facilities are expensive and can only treat a limited number of patients, resulting in denial of treatment or lengthy waiting periods.

EXAMPLES

  • Where access to medical treatments is limited, persons with disabilities may not be prioritized for treatment. For example, in the case of HIV and AIDS persons with disabilities may not receive antiretroviral therapy and post-exposure prophylaxis because of disability- related stigma and discrimination.
  • Privacy and confidentiality may be compromised for persons with disabilities seeking medical treatment or counselling owing to the presence of personal assistants or sign language interpreters.
  • Individuals who provide technical assistance to implement public health programmes often lack disability expertise and therefore leave disability out of their assessments and other work products (e.g. design of household surveys; outreach strategies).
  • Written materials on health matters may not be accessible to persons who are blind. Radio messaging cannot be accessed by persons who are deaf.

Country Checkpoint

What, in your view, are the most important barriers to health and personal social services for persons with disabilities? How may these barriers be reduced?

 

Barriers to Health and Social Services for Persons with Disabilities

  • lack of physical access, including transportation and/or proximity to clinics and, within clinics, lack of ramps, inaccessible scales and examination tables, inaccessible treatment and diagnostic equipment (including infusion chairs, mammography machines, and radiology equipment);
  • lack of information and communication materials (e.g. lack of materials in braille, large print, simple language, and pictures; lack of sign language interpreters, lack of materials for the deaf and persons suffering from hearing loss);
  • lack of private offices to discuss confidential health and social matters;
  • lack of extra time, care and attention to meet the needs of the disabled person;
  • lack of suitable water sources, toilets, washroom and restroom facilities;
  • lack of awareness, knowledge and understanding of the needs of disabled persons;
  • health-care and social service providers’ negative attitudes, prejudice and imposed stigma;
  • providers’ lack of knowledge and skills as regards persons with disabilities;
  • lack of coordination among health care providers;
  • lack of training of health care personnel; and
  • lack of funding, including lack of health-care insurance.

 

Important

Too often, even well intentioned policies treat persons with disabilities as a ‘target’, as a passive recipient of health and personal social services. Consultation with disabled persons and DPOs is essential to ensure that programmes meet needs effectively. The AAAQ framework (Availability, Accessibility, Acceptability and Quality) provides a useful framework for identifying obstacles to inclusive health care for persons with disabilities.

 

Country Checkpoint

What are obstacles to healthcare in your country in terms of the AAAQ Framework?

[1] WHO: Disability and Rehabilitation Team: www.who.int/disabilities.