Healthcare providers' perspectives of providing primary healthcare services to persons with physical disabilities in rural Ghana

From legislation to actual health service: evaluation of health provisions in the disability law of Ghana by adolescents with mobility and visual impairments and their families

BACKGROUND

Despite Ghana's Persons with Disability Act, 2006 (Act 715) making provisions for access to healthcare services for adolescents with disabilities and their families, a corpus of literature has reported that persons with disabilities continue to face challenges in accessing healthcare services. However, the voices of adolescents with disabilities and their families are very scarce in such discourse. This study explored the experiences of adolescents with disabilities and their families in accessing healthcare services as per the provisions described in Ghana's Act 715.

METHODS

This study involved 45 participants, including 25 adolescents with disabilities and 20 family members from a municipality in Ghana. Employing a qualitative descriptive design, semi-structured interviews were conducted which was then analyzed thematically and interpreted using Critical Disability Theory.

RESULTS

The study identified two major categories of barriers to healthcare access: environmental (socio-economic difficulties, poor built environment, unavailability of rehabilitation services) and systemic (cultural beliefs, poor support at healthcare facilities and inadequate healthcare legislative provisions for families of children with disabilities). Despite legal provisions for free healthcare, participants faced significant financial barriers, with specialist services often not covered by the National Health Insurance Scheme.

CONCLUSIONS

The study calls for policy adjustments to fully cover specialist care under Ghana's National Health Insurance Scheme, establishment of local-level health assessment and resource centers, educational campaigns to change cultural perceptions, and training of healthcare workers to promote quality access to healthcare.

"Nothing about us, without us": stakeholders perceptions on strategies to improve persons with disabilities' sexual and reproductive health outcomes in Ghana

BACKGROUND

Persons with disabilities (PwDs) experience various adverse sexual and reproductive health (SRH) outcomes. However, there is a paucity of evidence on the strategies to improve their SRH outcomes. This study, therefore, used a pluralistic approach to explore PwDs and healthcare providers' (HPs) perspectives on how to improve the SRH of PwDs in Ghana.

METHODS

In-depth interviews were conducted with 62 purposively selected stakeholders (37 PwDs and 25 HPs) in the Kumasi Metropolis and Offinso North District. The data was subjected to reflexive thematic analysis.

RESULTS

Six major themes were generated from the data: Training for disability-sensitive and inclusive healthcare, Healthcare inclusivity - 'nothing about us, without us', Raising awareness for accessibility and equity, Impactful continuous monitoring and evaluation, Vital empowerment for self-reliance and Educating for disability-inclusive healthcare environment. These recommendations were synthesised to develop the THRIVE model-a comprehensive data driven framework from stakeholders that emphasises the importance of factors such as Training for disability-sensitive and inclusive healthcare, Healthcare inclusivity - 'nothing about us, without us', Raising awareness for accessibility and equity, Impactful continuous monitoring and evaluation, Vital empowerment for self-reliance and Enforcement of physical accessibility to improve their SRH outcomes.

CONCLUSION

Using the evidence based THRIVE model could facilitate the development and strengthening of existing interventions and policies including the disability Act 715 to improve the SRH access and outcomes of PwDs in Ghana and other low-and middle-income countries.

Role of actor networks in primary health care implementation in low- and middle-income countries: a scoping review

BACKGROUND

Primary health care (PHC) improvement is often undermined by implementation gaps in low- and middle-income countries (LMICs). The influence that actor networks might have on the implementation has received little attention up to this point.

OBJECTIVE

This study sought to offer insights about actor networks and how they support PHC implementation in LMICs.

METHODS

We reviewed primary studies that utilised social network analysis (SNA) to determine actor networks and their influence on aspects of PHC in LMICs following the five-stage scoping review methodological framework by Arksey and O'Malley. Narrative synthesis was applied to describe the included studies and the results.

RESULTS

Thirteen primary studies were found eligible for this review. Ten network types were identified from the included papers across different contexts and actors: professional advice networks, peer networks, support/supervisory networks, friendship networks, referral networks, community health committee (CHC) networks, inter-sectoral collaboration networks, partnership networks, communications networks, and inter-organisational network. The networks were found to support PHC implementation at patient/household or community-level, health facility-level and multi-partner networks that work across levels. The study demonstrates that: (1) patient/household or community-level networks promote early health-seeking, continuity of care and inclusiveness by enabling network members (actors) the support that ensures access to PHC services, (2) health facility-level networks enable collaboration among PHC staff and also ensure the building of social capital that enhances accountability and access to community health services, and (3) multi-partner networks that work across levels promote implementation by facilitating information and resource sharing, high professional trust and effective communication among actors.

CONCLUSION

This body of literature reviewed suggests that, actor networks exist across different levels and that they make a difference in PHC implementation. Social Network Analysis may be a useful approach to health policy analysis (HPA) on implementation.

Healthcare Stakeholders' Perspectives on Challenges in the Provision of Quality Primary Healthcare for People with Disabilities in Three Regions of Guatemala: A Qualitative Study

It is estimated that 3.75 billion people worldwide lack access to healthcare services. Marginalized populations, such as people with disabilities, are at greater risk of exclusion. People with disabilities not only face the same barriers as people without disabilities, but also experience a range of additional barriers in accessing healthcare due to a variety of discriminatory and inaccessible environments. These extra barriers exist despite their greater need for general healthcare, as well as specialized healthcare related to their impairment. Few studies have focused on healthcare providers and the challenges they face in caring for this group. This paper describes the perspectives of healthcare stakeholders and reported challenges to the provision of quality primary healthcare for people with disabilities. In-depth interviews with 11 healthcare stakeholders were conducted in three regions of Guatemala. Data were analyzed using thematic analysis. Five sub-themes emerged from the above theme: infrastructure and availability of resources, impairment-based challenges, need for special attention and empathy, opportunity to provide services to people with disabilities, and gaps in training. The results could contribute to the development and implementation of strategies that can improve primary care provision and ultimately access to services for people with disabilities in low- and middle-income countries.

Violence in rural areas against disabled people from the perspective of their families

OBJECTIVES

to know the violence spoken and felt by disabled people, living in rural areas, from the perspective of their families.

METHODS

a descriptive-exploratory and qualitative study, carried out in four municipalities in Rio Grande do Sul, Brazil. Twelve family members who lived with disabled people in rural areas participated. Data were collected through semi-structured interviews and analyzed using thematic content analysis.

RESULTS

disabled people, living in rural areas, experienced physical, psychological and sexual violence, perpetrated by family members, colleagues, community members and health professionals. Adaptations were mentioned in family dynamics for the care of disabled people, social, financial and leisure impacts, and challenges in access and accessibility to education and health services.

FINAL CONSIDERATIONS

violence against this population manifests itself in a reality with socioeconomic and family particularities, marked by exclusion, disrespect and denial of rights and access to fundamental goods and services.

“Sex Should Not be Part of the Lives of Persons with Disabilities, but They Are Human Beings too”: Perceptions of Healthcare Providers and Factors Affecting Service Delivery in Ghana

Persons with disabilities (PwDs) constitute about 16% of the global population and face many challenges in every society, including access to sexual and reproductive healthcare. The attitudes of healthcare providers (HPs) exert a major influence on PwDs accessing sexual and reproductive healthcare (SRH). A sequential explanatory mixed methods design was used to investigate the attitudes and perceptions of HPs towards PwDs and SRH delivery in Ghana’s Ashanti region. Quantitative data analysis indicated that overall, 82% of HPs had received information on disability-related issues and had relatively positive attitude towards PwDs, which varied across sub-scales of the Attitude Towards Disability score and associated with their sociodemographic characteristics. HPs faced several challenges in SRH services delivery to PwDs, which included a lack of funding and training, and inadequate staff. Inductive thematic analysis of the qualitative data revealed eight overarching themes. The findings revealed that HPs had prejudice about the mental and sexual health abilities of PwDs. Inadequate skill set, inadequate resources, and limited funding were major challenges identified. Nonetheless, compassion and benevolence towards PwDs, improvision, economic and educational support, awareness creation, and referrals were strategies adopted to overcome these challenges. Mandatory training of HPs is recommended to ensure improved SRH service delivery to PwDs. Future research could explore the perceptions and coping strategies of PwDs.

Service providers' perspectives in providing services to children with disabilities and their families in Bangladesh

PURPOSE

This study seeks to gain an understanding of access to rehabilitation services and disability allowances for children with disabilities and their families from the perspectives of service providers.

METHOD

We interviewed 21 service providers in Bangladesh and used thematic analysis to analyze data.

RESULTS

Participants reported their perspectives on two major themes: (a) challenges in providing services to children with disabilities (e.g., limited availability of services and favouritism); and (b) facilitators in providing services to children with disabilities (e.g., cooperation from community leaders and satisfaction).

CONCLUSION

Providers' perspectives revealed unique insights that might be interesting for policymakers, practitioners, and researchers. The findings reinforce the need to consider the availability of rehabilitation professionals and disability allowances to meet the greatest needs of children with disabilities and their families in Bangladesh. The findings also call for further research on policymakers' perspectives on addressing the systemic issues encountered by providers in providing support to children with disabilities and their families in Bangladesh.Implications for RehabilitationRehabilitation services are critical for children with disabilities to achieve optimal health, wellbeing and human rightsThe government of Bangladesh has increased rehabilitation services for children with disabilities, but there is a need for further investment to increase rehabilitation workforceIt is important to strengthen monitoring and evaluation of disability-specific programs to ensure equitable access to services for children with disabilities.