title: Perceived Barriers for Accessing Health Services among Individuals with Disability in Four African Countries.
abstract: There is an increasing awareness among researchers and others that marginalized and vulnerable groups face problems in accessing health care. Access problems in particular in low-income countries may jeopardize the targets set by the United Nations through the Millennium Development Goals. Thus, identifying barriers for individuals with disability in accessing health services is a research priority. The current study aimed at identifying the magnitude of specific barriers, and to estimate the impact of disability on barriers for accessing health care in general. A population based household survey was carried out in Sudan, Namibia, Malawi, and South Africa, including a total of 9307 individuals. The sampling strategy was a two-stage cluster sampling within selected geographical areas in each country. A listing procedure to identify households with disabled members using the Washington Group six screening question was followed by administering household questionnaires in households with and without disabled members, and questionnaires for individuals with and without disability. The study shows that lack of transport, availability of services, inadequate drugs or equipment, and costs, are the four major barriers for access. The study also showed substantial variation in perceived barriers, reflecting largely socio-economic differences between the participating countries. Urbanity, socio-economic status, and severity of activity limitations are important predictors for barriers, while there is no gender difference. It is suggested that education reduces barriers to health services only to the extent that it reduces poverty. Persons with disability face additional and particular barriers to health services. Addressing these barriers requires an approach to health that stresses equity over equality.
authors.affiliation: SINTEF Technology and Society, Oslo, Norway; Stellenbosch University, Stellenbosch, South Africa.
authors.forename: Arne H
authors.initials: AH
authors.lastname: Eide
authors.affiliation: Trinity College, University of Dublin, Dublin, Ireland.
authors.forename: Hasheem
authors.initials: H
authors.lastname: Mannan
authors.affiliation: Afhad University for Women, Omdurman, Sudan.
authors.forename: Mustafa
authors.initials: M
authors.lastname: Khogali
authors.affiliation: University of Namibia, Windhoek, Namibia.
authors.forename: Gert
authors.initials: G
authors.lastname: van Rooy
authors.affiliation: Stellenbosch University, Stellenbosch, South Africa.
authors.forename: Leslie
authors.initials: L
authors.lastname: Swartz
authors.affiliation: University of Malawi, Zomba, Malawi.
authors.forename: Alister
authors.initials: A
authors.lastname: Munthali
authors.affiliation: SINTEF Technology and Society, Oslo, Norway.
authors.forename: Karl-Gerhard
authors.initials: KG
authors.lastname: Hem
authors.affiliation: Trinity College, University of Dublin, Dublin, Ireland.
authors.forename: Malcolm
authors.initials: M
authors.lastname: MacLachlan
authors.affiliation: SINTEF Technology and Society, Oslo, Norway.
authors.forename: Karin
authors.initials: K
authors.lastname: Dyrstad
mesh_terms: D000328:Adult; D000349:Africa; D006233:Persons with Disabilities / Q000706:statistics & numerical data*; D005191:Family Characteristics; D005260:Female; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006301:Health Services Needs and Demand / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D010465:Perception; D012923:Social Class; D011795:Surveys and Questionnaires