CHALLENGES IN ACCESSING PRIMARY HEALTHCARE FOR CHILDREN WITH DISABILITIES IN ENUGU STATE: PERSPECTIVES FROM STAFF OF HEALTHCARE AGENCIES
Main Article Content
Keywords
children with disabilities, primary healthcare, healthcare access, healthcare agencies, disability, universal health coverage, Enugu State, Nigeria
Abstract
Background: Children with disabilities (CWDs) frequently encounter multiple and interrelated barriers to accessing primary healthcare. These barriers may occur at individual, community, health-facility and health-system levels and may undermine equitable access to healthcare and the achievement of universal health coverage (UHC). The study aims to explore the perspectives of staff of healthcare agencies regarding challenges encountered in accessing primary healthcare for CWDs in Enugu State, Nigeria.
Methods: A phenomenological qualitative design was used as part of a broader study examining healthcare access for CWDs attending special schools in Enugu State. Three healthcare-agency staff representing relevant government health agencies, including the National Health Insurance Authority (NHIA), Universal Health Coverage (UHC) and National Primary Health Care Development Agency (NPHCDA), participated in in-depth interviews. The wider study included 56 participants comprising special-school staff, parents, healthcare providers and healthcare-agency staff. Data were collected using semi-structured interview guides and analysed thematically. Policy documents relating to disability rights and healthcare access were also reviewed.
Results: Healthcare-agency staff identified interconnected challenges involving awareness and communication, transportation and physical accessibility, availability of appropriate healthcare personnel and equipment, affordability and limitations of health-insurance coverage, and negative attitudes towards CWDs. Limited awareness of disability-related legislation was evident among some agency personnel. One agency participant reported knowledge of UHC but limited knowledge of other relevant international policies, while agency staff demonstrated differing levels of knowledge regarding the Discrimination Against Persons with Disabilities (Prohibition) Act (DAPDAN). Transportation was particularly problematic for children using wheelchairs, with difficulties involving vehicle access, transfer between wheelchairs and vehicles, and additional transportation costs. Agency staff also identified the absence of disability-specific communication support, including sign-language interpreters, within healthcare facilities. Health-insurance limitations included inadequate coverage of disability-related needs and the absence of specific provisions for CWDs in the studied setting. Negative attitudes and stigma were also reported in public and family environments.
Conclusion: From the perspective of healthcare-agency staff, inadequate access to primary healthcare for CWDs in Enugu State reflects a system-wide problem extending beyond the physical availability of healthcare facilities. Strengthening disability-responsive financing, transportation, communication support, healthcare infrastructure, provider competence, public awareness and implementation of disability-related legislation is necessary to advance equitable healthcare access and UHC.
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