A Systematic Review of Access to General Healthcare Services for People with Disabilities in Low and Middle Income Countries

Abstract

Background: A systematic review was undertaken to explore access to general healthcare services for people with disabilities in low and middle-income countries (LMICs). Methods: Six electronic databases were searched in February 2017. Studies comparing access to general healthcare services by people with disabilities to those without disabilities from LMICs were included. Eligible measures of healthcare access included: utilisation, coverage, adherence, expenditure, and quality. Studies measuring disability using self-reported or clinical assessments were eligible. Title, abstract and full-text screening and data extraction was undertaken by the two authors. Results: Searches returned 13,048 studies, of which 50 studies were eligible. Studies were predominantly conducted in sub-Saharan Africa (30%), Latin America (24%), and East Asia/Pacific (12%). 74% of studies used cross-sectional designs and the remaining used case-control designs. There was evidence that utilisation of healthcare services was higher for people with disabilities, and healthcare expenditure was higher. There were less consistent differences between people with and without disabilities in other access measures. However, the wide variation in type and measurement of disability, and access outcomes, made comparisons across studies difficult. Conclusions: Developing common metrics for measuring disability and healthcare access will improve the availability of high quality, comparable data, so that healthcare access for people with disabilities can be monitored and improved.

Barriers to accessing primary healthcare services for people with disabilities in low and middle-income countries, a Meta-synthesis of qualitative studies

“…Articles were screened into two groups. One group was qualitative papers focusing on access to primary healthcare by people with disabilities in LMIC for this current review, while the second was for a quantitative systematic review focusing on access and uptake of general healthcare services in LMIC by people with disabilities completed by TB and HK [23]. In July 2019, the same database search strategy was applied again by TB for the period of 2017-2019, to update the qualitative literature review, with the inclusion of additional terms to limit the findings to qualitative studies only.…”

“…Evidence from high income contexts suggests that, in comparison to non-disabled people, people with disabilities attend fewer routine health examinations [19], and are less likely to receive preventive care [14,[20][21][22]. This impact on healthcare access has also been reflected in data from LMICs [23]. While limited, evidence also suggests that when people with disabilities do seek healthcare, they receive poorer quality services [16,[24][25][26][27] and incur greater expenses [4,26].…”

“…Clearly then, depending on how access or barriers to accessing healthcare are measured, some of the barriers experienced by people with disabilities may be subtle, hidden, and interlinked, and as a result are best described and explored qualitatively. There has been a significant increase in the number of studies, both quantitative [23] and qualitative, published on access to healthcare for people with disabilities over the past 10 years. This increase may be partially due to the increased visibility of disability as an issue, promoted by World Report on Disability and the release of WHO Global Disability Action Plan 2014-2021: Better Health for All People with Disabilities [29].…”

Association of anxiety and depression with physical and sensory functional difficulties in adults in five population-based surveys in low and middle-income countries

“…Despite these limitations, it does appear that the prevalence of mental health conditions is linked to the presence of physical/sensory functional difficulties. Access to rehabilitation and mental health services is frequently poor in LMICs [19], and there are well documented barriers to healthcare access for individuals with a disability [31,32]. The association of mental health and physical/sensory functional difficulties implies that there should be more integrated care between rehabilitation/specialist care and mental health services, and that general/primary healthcare services should be aware of comorbidities and multiple support requirements.…”

No One Left Behind? Comparing Poverty and Deprivation between People with and without Disabilities in the Maldives

“…The United Nations Convention on the Rights of People with Disabilities (UNCRPD), which has been ratified by 177 countries, codifies the rights of people with disabilities to full inclusion on an equal basis as others [5,6]. However, people with disabilities still face large inequalities in realising their rights, which is evident by disparities compared to people without disabilities in social participation and access to education, healthcare, and employment [7][8][9].…”