Improving the Maternal Healthcare Quality for Women with Disabilities in Nepal

Abstract

Introduction ​This study identifies approaches to quality improvement for women with disabilities in Nepal from the perspective of the women themselves and the policymakers. Nepal has seen significant progress in maternal healthcare, including a marked reduction in maternal mortality. However, this progress masks disparities, particularly for women with disabilities. The study aims to address the gap in quality of maternal healthcare for these women, in light of Nepal’s evolving healthcare policies and federal structure. Studies have been conducted on quality improvement for maternal health but few studies have been done from both perspectives.Methods Qualitative data was collected through in-depth semi-structured interviews with two groups: 12 women with visual and physical disabilities, and 12 policymakers at different administrative levels. Conducted in the outskirts of Kathmandu, these interviews were audio-recorded, transcribed, translated into English, and analyzed thematically.Results Women with disabilities in Nepal highlighted significant healthcare challenges, including inadequate disability-friendly infrastructure, scarce resources like wheelchairs and interpreters, understaffing, financial barriers, and lack of adequately trained healthcare staff. They advocated for better policy enforcement, increased staff training, and self-education on disability effects. Policymakers acknowledged these issues, noting improvements in infrastructure after the 2015 federalization of Nepal, but noted financial constraints and a lack of staff training and awareness. They suggested leveraging private funds and NGO collaboration for better resource allocation and emphasized the potential of local government initiatives for more tailored healthcare solutions.Conclusion In this study examining healthcare quality improvements, women with disabilities and policymakers agreed on the necessity of enhanced infrastructure, resources, and state financing, but diverged in their perceptions of progress and implementation strategies. Policymakers view current efforts optimistically and favor leveraging private funding, whereas women report insufficient improvements and neglect. Both groups value healthcare provider training, yet differ on approaches to achieve it. To address these disparities, the study recommends interactive workshops for shared understanding, strategic optimization of state spending, and curriculum updates to include specialized training for healthcare providers, aiming to unify efforts towards better healthcare for women with disabilities.