Inclusion of Persons with Disabilities in Primary Health Care Services in the Western Region of Nepal: An Explorative Study of Perceived Barriers

Abstract

Background: Compared to people in the general population, persons with disabilities face additional barriers to access primary health care services, especially in developing countries. Consequently, they have a greater vulnerability and a higher prevalence of secondary conditions, which are preventable physical, mental and social disorders resulting directly or indirectly from an initial disabling condition. With a focus on vulnerability, accessibility and exclusion to health services, this study aims to explore the perceived barriers of persons with disabilities to access primary health care services in the Western region of Nepal. Based on the Institute Of Medicine framework, Health belief model and a stigma-related model, perceptions on structural, financial and personal/cultural barriers are explored. Methods: 21 semi-structured interviews were conducted with health care providers and persons with disabilities (with locomotive or visual impairments) in the hilly and lower areas. Results: Structural barriers were transportation, poor quality of care in general and for disability specific needs and the lack of governmental support. Financial barriers were lack of funds for health expenses mainly due to problems in generating an income by persons with disabilities themselves. Furthermore, personal/cultural barriers were reported, as in being unaware of existing health facilities, preference of other health facilities (private or traditional medicine) and stigma by family members and the community. Furthermore, self-stigma highly influenced the family’s attitude and the motivation to seek for health care. Lastly, poor public awareness of the society about their needs was reported. Conclusions: Programs and policies should focus on the inclusion of disabled persons, within health education, and promotion and income generating activities. Activities to reduce stigma of persons with disabilities should take place, with emphasis on the attitude of families and reduction of self stigma. Training should be provided to mainstream health organizations, especially the governmental services. Keywords: health care providers; perceived barriers; persons with disabilities; primary health care services.