Access to health care for persons with disabilities in rural South Africa

R Vergunst; L Swartz; K-G Hem; A H Eide; H Mannan; M MacLachlan; G Mji; S H Braathen; M Schneider

doi:10.1186/s12913-017-2674-5

Access to health care for persons with disabilities in rural South Africa

BMC Health Serv Res. 2017 Nov 17;17(1):741. doi: 10.1186/s12913-017-2674-5.

Authors

R Vergunst¹, L Swartz², K-G Hem³, A H Eide^{3

4}, H Mannan⁵, M MacLachlan^{4

6

7}, G Mji⁴, S H Braathen^{2

3}, M Schneider⁸

Affiliations

¹ Alan J Flisher Centre for Public Mental Health, Department of Psychology, Stellenbosch University, PO Box X1, Stellenbosch, Matieland, 7602, South Africa. rvergunst@sun.ac.za.
² Alan J Flisher Centre for Public Mental Health, Department of Psychology, Stellenbosch University, PO Box X1, Stellenbosch, Matieland, 7602, South Africa.
³ SINTEF Technology and Society, Department of Health Research, PB 124 Blindern, 0314, Oslo, Norway.
⁴ Centre for Rehabilitation Studies, Stellenbosch University, Stellenbosch, South Africa.
⁵ School of Nursing, Midwifery & Health Systems, Health Sciences Centre, University College Dublin, Dublin, Ireland.
⁶ ALL Institute and Department of Psychology, Maynooth University, Maynooth, Ireland.
⁷ Olomouc University Social Health Institute, Palacký University Olomouc, Olomouc, Czech Republic.
⁸ Alan J Flisher Centre for Public Mental Health Department of Psychiatry & Mental Health, University of Cape Town, Cape Town, South Africa.

Abstract

Background: Global research suggests that persons with disabilities face barriers when accessing health care services. Yet, information regarding the nature of these barriers, especially in low-income and middle-income countries is sparse. Rural contexts in these countries may present greater barriers than urban contexts, but little is known about access issues in such contexts. There is a paucity of research in South Africa looking at "triple vulnerability" - poverty, disability and rurality. This study explored issues of access to health care for persons with disabilities in an impoverished rural area in South Africa.

Methods: The study includes a quantitative survey with interviews with 773 participants in 527 households. Comparisons in terms of access to health care between persons with disabilities and persons with no disabilities were explored. The approach to data analysis included quantitative data analysis using descriptive and inferential statistics. Frequency and cross tabulation, comparing and contrasting the frequency of different phenomena between persons with disabilities and persons with no disabilities, were used. Chi-square tests and Analysis of Variance tests were then incorporated into the analysis.

Results: Persons with disabilities have a higher rate of unmet health needs as compared to non-disabled. In rural Madwaleni in South Africa, persons with disabilities faced significantly more barriers to accessing health care compared to persons without disabilities. Barriers increased with disability severity and was reduced with increasing level of education, living in a household without disabled members and with age.

Conclusions: This study has shown that access to health care in a rural area in South Africa for persons with disabilities is more of an issue than for persons without disabilities in that they face more barriers. Implications are that we need to look beyond the medical issues of disability and address social and inclusion issues as well.

Keywords: Access; Disability; Health; Rural; South Africa.

Publication types

Observational Study

MeSH terms

Adolescent
Adult
Aged
Aged, 80 and over
Child
Cross-Sectional Studies
Disabled Persons / statistics & numerical data*
Family Characteristics
Female
Health Services Accessibility / statistics & numerical data*
Healthcare Disparities / statistics & numerical data*
Humans
Male
Middle Aged
Poverty
Rural Health Services / supply & distribution*
Rural Population
South Africa / epidemiology
Young Adult

Grants and funding

223501/the European Commission Framework Programme 7; Project Title: Enabling Universal and Equitable Access to Healthcare for Vulnerable People in Resource Poor Settings in Africa;