Disability Research Group, MRC/UVRI and LSHTM Uganda Research Unit, Entebbe, Wakiso, Uganda
Department of Global Health and Development, London School of Hygiene & Tropical Medicine Faculty of Public Health and Policy, London, UK.
BMJ Open. 2024 Nov 2;14(11):e086194. doi: 10.1136/bmjopen-2024-086194.
The aim of the research was to explore the barriers to healthcare access for persons with various disabilities in rural Luuka district of Uganda. The findings will assist in appreciating the challenges persons with disabilities face in accessing Healthcare in a rural setting. These insights will contribute to the development of an intervention to improve healthcare access that is affordable, timely and acceptable.
This qualitative study formed the exploratory formative phase of the 'Missing Billion' project. A total of 27 participants with disabilities-visual impairment (n=5), physical impairment (n=5), multiple impairments (n=6) and intellectual/ cognitive impairment (n=5) were purposively selected to participate in in-depth interviews conducted by two experienced researchers. Participants were identified through contact lists provided by the district disability focal person and local disability associations, with additional participants identified through snowball sampling. Interviews with persons with hearing impairment (n=6) were conducted by a researcher with hearing impairment. The interviews were audio/video recorded and transcribed to facilitate thematic data analysis. We used the disability-inclusive health 'Missing Billion' framework to map and inform the barriers.
The study was conducted between September and November 2022 in rural communities in Luuka district, Eastern Uganda.
On the demand side, challenges revolved around autonomy and awareness, limited access to health information, lack of financial capacity and dependence on caregivers for healthcare choices left persons with disabilities feeling disempowered. On the supply side, discrimination and negative attitudes from healthcare workers were reported as prevalent. Absence of healthcare workers and service delivery delays impacted on healthcare access, resulting in poor care. Inaccessible healthcare facilities compounded issues, as they had limited accessibility features.
Complex and interconnected barriers underscore the pressing need for systemic changes to ensure equitable healthcare access for persons with disabilities in rural Uganda.
本研究旨在探讨乌干达卢卡农村地区各类残疾人士获得医疗保健的障碍。研究结果将有助于了解残疾人士在农村地区获得医疗保健所面临的挑战。这些见解将有助于制定一项改善医疗保健获取的干预措施，使其具有负担能力、及时和可接受。
这项定性研究是“Missing Billion”项目的探索性形成阶段。共有 27 名残疾人士（视力障碍 5 人，身体障碍 5 人，多重障碍 6 人，智力/认知障碍 5 人），通过区残疾问题协调员和当地残疾协会提供的联系人名单，有目的地选择参加由两位经验丰富的研究人员进行的深入访谈。此外，还通过滚雪球抽样确定了听力障碍参与者（6 人）。听力障碍研究人员对听力障碍人士进行了访谈。访谈进行了音频/视频记录，并转录为主题数据分析提供便利。我们使用包容性残疾健康“Missing Billion”框架来映射和告知障碍。
研究于 2022 年 9 月至 11 月在乌干达东部卢卡农村社区进行。
在需求方面，挑战围绕着自主权和意识、有限获取健康信息、缺乏财务能力以及依赖照顾者做出医疗保健选择，这些使残疾人士感到无力。在供应方面，报告称医护人员的歧视和消极态度普遍存在。医护人员的缺失和服务提供延迟影响了医疗保健的获取，导致护理质量差。医疗机构的可达性差，因为它们的无障碍功能有限，这也加剧了问题。
复杂且相互关联的障碍突出表明，迫切需要进行系统变革，以确保乌干达农村地区残疾人士公平获得医疗保健。
