Accessibility to healthcare is a fundamental human right aimed at facilitating better health outcomes for people with disabilities. However, the persistent gap between policy intents and actual implementation results in poorer health outcomes for people with disabilities, which is against universal health coverage.
This study explored policymakers’ perspectives on barriers to accessibility to healthcare services for people with disabilities.
Through purposive sampling, qualitative, descriptive, exploratory research was conducted among five policymakers in a rural constituency. Each participant signed an informed consent form. The face-to-face interview lasted 50–60 min and used validated semi-structured questions, audio recordings, and memos to capture data. Manual coding, employing an inductive approach and categorisation, was conducted, resulting in the formulation of themes.
Two main themes emerged: Systemic and structural challenges to inclusive healthcare, and training and attitudinal barriers to inclusive healthcare, highlighting transport and infrastructure barriers, as well as insufficient budget because of ineffective health policy implementation. A lack of training and discrimination were key issues reported.
This study highlighted key obstacles related to weak policy enforcement, inadequate infrastructure, stigma, and funding issues, which impede accessibility to health services for people with disabilities in Namibia.
Understanding how policies are translated into practice is crucial for closing implementation gaps and enhancing healthcare access for people with disabilities.
Access to healthcare is a fundamental human right aiming to facilitate better health outcomes; however, people with disabilities’ access to healthcare services is jeopardised by various limitations, including physical, systemic, attitudinal, and policy-related barriers. According to the World Health Organization (WHO), a population of 1.3 billion people, which is about 16% of the global population, live with some form of disability and experience exclusion from essential healthcare services because of discriminatory practices, inaccessible settings, and inappropriate policies (McClintock et al.
Globally, people with disabilities face considerable challenges in accessing healthcare services. They often experience higher rates of unmet health needs than the general population because of physical, financial, and systemic barriers (WHO
Although the Universal Health Coverage emphasised health for all, some barriers compromise the health outcomes of people with disabilities people with disabilities, which violates their rights (Cu et al.
Nevertheless, inclusive policy frameworks and disability laws are documented as part of state efforts to improve access to healthcare for people with disabilities (African Disability Forum
Most countries have adopted disability-inclusive policies in line with the CRPD. However, a gap exists between policy availability and implementation because of challenges such as inadequate funding, insufficient monitoring, limited disability-specific data, and limited intersectoral collaboration (Muhammad
Research methods are forms of data collection, analysis, and interpretation that researchers use when proposing studies (Creswell
The research design is the plan for conducting the study, specifying the type of data to be collected and the methods used (Creswell
A qualitative, descriptive, exploratory, and contextual study design was used to investigate the experiences of policymakers to investigate how policies address access to healthcare for people with disabilities in Omulonga constituency. Namibia is divided into 14 regions, which are further subdivided into 121 constituencies. The Ohangwena region consists of 12 constituencies, including Omulonga, where this study was conducted.
A population refers to an entire group that meets the inclusion criteria and is suitable for the study (Nieswiadomy & Bailey
The population was five government employees and one traditional authority disability coordinator. They represent a particular unit or programme that implements government policies at the constituency level, and their participation provides input to the law-making process through consultation, ensuring that the interests of the constituency are reflected in national legislation through regional representation. Policymakers should have at least 2 years of experience and have worked with laws and regulations related to disability affairs.
Participants were identified through purposive sampling. Purposive sampling is a non-probability technique in which participants are intentionally selected based on their ability to provide relevant and rich information for the study (Gray & Grove
Data collection is the process of gathering data through various techniques and contexts to address the study’s research questions (Nieswiadomy & Bailey
A semi-structured interview guide, validated with assistance from a peer researcher and a supervisor, was used to explore policymakers’ perspectives on disability-related matters. Interviews were conducted in September 2023 for a week after the primary researcher received ethical approval and the necessary permissions to conduct the study. The primary researcher consults with the coordinator of disability affairs and the constituency counsellor for gatekeeper permission to conduct the interviews. The researcher introduces the research team and explains the study’s purpose to each participant before the interview. Each face-to-face interview was conducted at the participant’s workplace, in a quiet area, after the participant signed the consent form. Permission to use an audio recorder was obtained from each participant at the start of the interview, which lasted 50–60 min. Data collection tools, such as an audio recorder and field notes, were used to capture information and observations, respectively. Interviews were conducted in English, the country’s official language, and all participants communicated smoothly. Data saturation was reached when no new information emerged.
Data were analysed using thematic analysis, which involved transcription, coding, categorisation, and theme development to identify patterns in participants’ experiences (Brink, Walt & Rensburg
The researcher revisits all data for each theme to ensure that the themes accurately reflect the participants’ perspectives. Each final theme was developed through clear definitions and supported by illustrative quotes from participants. The report was written based on existing literature and participants’ accounts, and Grammarly was used to edit the text.
Dependable and credible techniques were used, as emphasised by methodological authors (Creswell & Poth
The primary researcher kept reflexive notes and discussed them with a peer researcher to ensure that assumptions did not influence the findings and that the analysis reflected participants’ responses (Korstjens & Moser
Ethical clearance to conduct this study was first obtained by the corresponding author from the Biomedical Research Ethics Committee (Protocol reference number: BREC/00005244/2023) at the University of KwaZulu-Natal, and permission to conduct the study from the Namibian Ministry of Health and Social Services (Reference: 22/4/2/3). The researcher also obtained gatekeeper permission from the counsellor of Omulonga constituency before embarking on data collection. Each participant signed an informed consent before the interview. Participation was voluntary, with an option to withdraw without penalty if one felt uncomfortable during the process. All data were treated with strict confidentiality throughout the study. Participants’ identities were protected by using pseudonyms instead of their real names. Any identifying information was removed from transcripts and research records to ensure anonymity. Electronic data were password-protected, and hard copies were securely stored in a locked cabinet accessible only to the researcher.
Most participants were male and older, and had sufficient exposure to policy-related matters affecting people with disabilities (see
Socio-demographic characteristics of participants.
| Participant | Age group(years) | Gender | Years of experience | Government employee |
|---|---|---|---|---|
| PM_1 | 58–67 | Male | 25 | No |
| PM_2 | 48–57 | Male | 12 | Yes |
| PM_3 | 38–47 | Female | 4 | Yes |
| PM_4 | 28–37 | Female | 3 | Yes |
| PM_5 | 28–37 | Male | 5 | Yes |
PM, policymaker.
Government employees and traditional leaders characterise the participants’ socio-demographic characteristics. The participants’ age distribution reflects their actual ages at the time of data collection; however, the age groups (years) were used to ensure anonymity.
Analysis of interview transcripts from policymakers revealed several interrelated barriers that hinder access to healthcare services for people with disabilities. Two key themes emerged, each supported by direct expressions from participants. Theme 1 focuses on systemic and structural challenges to inclusive healthcare, including transportation and infrastructure for healthcare access and inadequate policy implementation, as subthemes.
Theme 2 focuses on training and attitudinal barriers to inclusive healthcare, encompassing issues such as the impact of a lack of training on disability matters and the impact of stigma and discrimination on people with disabilities.
The ability to provide effective, inclusive healthcare services is hindered by several systemic and structural challenges that are beyond the control of healthcare providers.
‘The lack of transport makes it difficult for them [
‘Most of the time, these people want to travel, they must book a car, and they are going to pay as far as N$200 for taking them from the village to the hospital. So, it is costly, and it is difficult for them, especially those who are living in remote areas.’ (PM_5)
Consequently, a physical barrier is described by participants in terms of inaccessible infrastructure, which limits the ability of people with disabilities to navigate and use the healthcare facilities. Participants narrated that mobility within these facilities becomes a struggle because of a lack of user-friendly infrastructure. Participants raised concerns about the poor state of healthcare infrastructure, particularly regarding accessibility for people with disabilities. Healthcare facilities lack ramps and wide entrances, making it difficult for wheelchair users and people with mobility impairments to access services independently without their family members. The lack of inclusive design led to dependence and discouraged frequent visits to health services:
‘Sometimes even the narrowness is just not friendly, so that the wheelchair can fit. We always recommend people to build infrastructures that are environmentally friendly.’ (PM_5)
‘One thing that I have noticed about our health centres is that they are not built in a way that is sometimes accessible to persons using wheelchairs.’ (PM_3)
Equally, policymakers mentioned the need to improve the structure of sanitation facilities, noting that most health facilities do not accommodate people with disabilities. Toilets are often too small for wheelchairs, requiring the architects to integrate provisions for people with disabilities in their designs. As a result of the sanitation challenges, people with disabilities frequently stay away from the healthcare services to avoid discomfort:
‘Yes, specialised toilets are crucial, to be designed to meet the unique needs of children with disabilities for hygiene and ease of use.’ (PM_4)
‘Our focus should be on making all constructions inclusive, which means creating entrances and exits that cater to wheelchair users and those relying on crutches.’ (PM_2)
Inadequate policy implementation: Another challenge reported by participants is a systemic issue related to inadequate policy implementation, reflected in insufficient funding and non-compliance with policy frameworks. Policymakers in disability affairs reported that funding for disability-specific services and infrastructure remains very limited. They have expressed that poor budgetary planning is affecting service delivery, as there is often non-compliance with fiscal policies. The funding gap implies that disability issues are not considered necessary, resulting in a significant lack of provision of assistive devices:
‘We did not provide wheelchairs because the budget was not enough, and sometimes, we failed to identify those in need of wheelchairs.’ (PM_2)
‘It is a budget issue; they tell you they do not have money for that. I think the government needs to increase the budget allocated for persons with disabilities. Disability is mentioned in planning, but when the money comes, it’s not prioritised.’ (PM_5)
Although policymakers acknowledged the presence and use of supportive laws and policies to guide outreach programme planning and resource allocation, they also found barriers to implementing these policies because of inconsistent enforcement across service providers. They indicated a lack of awareness, weak enforcement mechanisms, and the absence of monitoring systems. This separation between policies and practices results in inconsistent and inadequate health service delivery to people with disabilities:
‘We have laws and policies, but they are collecting dust on our tables. We do not read the stipulations stated in policies to identify the remedial actions. And we fail to monitor the implementation, and secondly, we fail to evaluate whether that policy makes an impact [
‘I might not be familiar with the policy and what it says, but all I know is that everybody has the right to healthcare facilities. For example, when they go to the hospital, they do not need to pay. They have access to clinics. Accessibility is there.’ (PM_3)
A lack of policy implementation, as narrated by participants, results in unprioritised health services that create barriers hindering efficient service delivery to people with disabilities. Participants narrated a concern relating to the lack of prioritising persons with severe disabilities for treatment at healthcare facilities:
‘There is no specialised treatment for different disability categories, leading to challenges for those with visual impairments and those seeking general services. The queue is the same.’ (PM_2)
‘I think people with disabilities are struggling everywhere they are. Everything is difficult for them to get. So why don’t we just give them priority when it comes to health? Just imagine somebody who is already struggling to walk or who is sitting in a wheelchair, and so on. So, I think it is high time we prioritise them, whereby they come and queue to be attended to first to proceed.’ (PM_5)
Subsequently, policymakers expressed the need for collaborative arrangements to enhance service efficiency, reduce duplication of effort, and improve overall health service delivery for people with disabilities, especially those with multiple or severe impairments. They suggested a referral system that includes departments, non-governmental organisations (NGOs), and social service providers to improve access to healthcare for people with disabilities:
‘People should just work together and put more effort into helping people with disabilities, and things should not be done in isolation; they need to collaborate.’ (PM_1)
‘Major services, especially for visual impairments, require referral to district hospitals. Traveling to these locations requires energy and transportation. Equally, the involvement of stakeholders in the drafting and implementation of policies helps bridge the gap between legislation and practical application.’ (PM_2)
Training and attitudinal barriers to inclusive healthcare services had an impact on people with disabilities’ access to health services in their context. This was expressed as follows:
The impact of a lack of training on disability matters: Participants highlighted that the lack of training on disability matters influences inclusive service delivery to people with disabilities. They emphasised the need to train healthcare providers to improve accessibility, noting that most have not received adequate training and therefore lack competence in treating and interacting with people with disabilities. As a result, people with disabilities are often misdiagnosed and discriminated against when seeking healthcare. Healthcare providers usually lack the knowledge and skills to communicate effectively in sign language and interpret treatment procedures for individuals with sensory disabilities. Healthcare providers also lack the skills to handle mental health patients:
‘I am just expressing the importance of giving information on disability, until such a time that everybody is educated on disability, very few people will understand the needs of people with disabilities. Also, the community at the villages, but even healthcare providers, general policymakers, parliamentarians, the councils, and the police drafters, need to be sensitised when it comes to disabilities.’ (PM_5)
‘The communication barrier is substantial. Even healthcare providers struggle to understand sign language, making it challenging for people who are hard of hearing to convey their health concerns. Visual impairments also pose challenges, particularly when attempting to comprehend written information. We need solutions that address these issues, perhaps even trained personnel to assist.’ (PM_2)
The lack of training in disability matters translates into another challenge, which impacts healthcare access to people with disabilities:
The impact of stigma and discrimination on people with disabilities: Negative attitudes and discriminatory behaviours among the healthcare providers were noted by participants, who narrated that some healthcare providers display negative attitudes and discriminatory behaviours when treating people with disabilities. Such attitudes contribute to feelings of exclusion, disempowerment, and mistrust in the health system. Likewise, family members do not disclose the presence of people with disabilities because of the fear of discrimination. This behaviour affects the ability to seek healthcare, resulting in delayed treatment:
‘This stereotype is among the society itself and is not exclusive to the healthcare providers; they might do this equally.’ (PM_5)
‘There is a need to have a specific programme focusing on the caregivers of people with disabilities. Why am I saying that? There are cases where a family has a person with disabilities, but they are not open. There are those cases of persons with disabilities who stay in the houses; they do not even go out.’ (PM_3)
This study aimed to investigate policymakers’ perspectives on access to healthcare services for people with disabilities. The study revealed several interrelated barriers that hinder access to healthcare services for people with disabilities, who are affected mainly by inequality because of social limitations. The crucial challenges mentioned are the unavailability of transport to support people with disabilities in accessing health services, infrastructures that are not in favour of people with disabilities, and a limited budget that hampers the policy’s implementation. As a result, efficient healthcare provision is hindered, limiting full access to healthcare. Based on these findings, the discussion will focus on the key themes and will be supported with literature.
Policymakers in this study mentioned systemic and structural barriers affecting people with disabilities in healthcare access. Participants found that the transport system remains a key obstacle, especially in rural areas, where disability-friendly public transport is hindered by poor road infrastructure, which restricts access to health services. The outcome aligns with findings from earlier studies, which underscore the importance of transport as a significant determinant of healthcare access for people with disabilities, leading to financial strain (Mitra et al.
Another critical barrier identified was the inappropriate design of healthcare facility buildings. Institutional documents highlight promising expectations for policy plans to improve and expand infrastructure for people with disabilities; however, these were hindered by limited policy implementation and budget constraints (Republic of Namibia
This study found that there is often insufficient budget allocation for disability affairs. Participants reported a lack of funding for assistive devices, infrastructure, and sanitation suitable for people with disabilities. This finding is consistent with the conclusions of several global reports, which emphasise that without adequate funding, disability-inclusive healthcare policies remain largely symbolic (WHO
Policymakers reported the existence of supportive policy documents, such as the
Participants in this study emphasised the importance of prioritising people with disabilities in service delivery, particularly those with mobility challenges, so they are attended to first when queuing for health services. The existing services hinder the welfare of people with disabilities, as they lack reminders for follow-up appointments and delay prompt treatment. The findings challenge the recommended directives of the equity-based approach in healthcare that aims to provide preferential treatment for persons with disabilities (WHO
The findings also show training gaps among healthcare providers. Participants emphasised the need to train healthcare providers, particularly in sign language, to enhance communication. Many providers lack knowledge and skills related to disability affairs, which can lead to inadequate diagnosis and treatment for people with disabilities. This finding aligns with previous research that advocates for disability competency training across all health professions for positive health outcomes of people with disabilities (Belay
Participants reported negative attitudes and discriminatory behaviours among the healthcare providers in the care of people with disabilities. Stigma and discrimination in healthcare settings and family households were found to be pervasive, particularly towards people with intellectual and psychosocial disabilities. Previous studies have shown that stigma leads to social exclusion and poorer healthcare outcomes for people with disabilities, further establishing health disparities (Iezzoni et al.
A key strength of this study was policymakers’ discovery of barriers to effective healthcare access for people with disabilities, which requires a comprehensive approach to efficient service delivery in line with the
This study has implications for policy and practice regarding policy reforms, the implementation of health services interventions, and their monitoring across various sectors. There is a need to include disability in the training curriculum for healthcare professionals, with a focus on basic awareness, communication strategies, and ethical considerations to promote positive behaviours among healthcare providers.
The government must take a more proactive role in ensuring that disability-inclusive policies are adequately funded, implemented, and effectively monitored. There should be sufficient funding for accessible infrastructure, especially for mobility-challenged individuals, funds for staff training, and disability awareness outreach to destigmatise the perception of disability.
Future studies can utilise this study’s findings to investigate the factors that facilitate the implementation of inclusive policies. Proposed studies could also include the views of other stakeholders involved in disability affairs across various governmental and non-governmental agencies at the regional and national levels. Comparative studies can be used to develop databases of people with disabilities for alignment with health service provision.
The study identified several barriers influencing access to health services for people with disabilities. Key obstacles included transportation challenges, inadequate infrastructure because of limited funding, weak policy enforcement, and a lack of awareness of disabilities among service providers. These factors contribute to stigma, discrimination, and social exclusion, ultimately leading to poorer health outcomes. There is a need to address the barriers through targeted training, stronger policy implementation, and sufficient funding to enhance inclusivity and equity in health service provision for people with disabilities.
The authors would like to thank the University of KwaZulu-Natal, the College of Health Sciences, and Namibia’s Ministry of Health and Social Services for authorising this study. The researchers show appreciation to the participants in this study and the community leaders in Omulonga constituency for the permission to conduct the study in their area of jurisdiction.
This article is based on research originally conducted as part of Hileni N. Niikondo’s doctoral thesis titled ‘Developing strategic framework to facilitate access to health services for people with disabilities in Omulonga constituency, Ohangwena region, Namibia’, to be submitted to the School of Nursing and Public Health, College of Health Sciences, University of KwaZulu-Natal, in 2026. The thesis is being supervised by Sipho W. Mkhize. The manuscript has since been revised and adapted for journal publication. The original thesis is not yet published, and the publication of the manuscript is a requirement for thesis submission.
The authors declare that they have no financial or personal relationships that may have inappropriately influenced them in writing this article.
Hileni N. Niikondo: Conceptualisation, Data curation, Formal analysis, Investigation, Methodology, Project administration, Resources, Software, Visualisation, Writing – original draft, Writing – review & editing. Sipho W. Mkhize: Conceptualisation, Formal analysis, Methodology, Resources, Supervision, Writing – review & editing. All authors reviewed the article, contributed to the discussion of results, approved the final version for submission and publication, and take responsibility for the integrity of its findings.
The research data that support the findings of this study are available from the corresponding author, Hileni N. Niikondo, upon request.
The views and opinions expressed in this article are those of the authors and are the product of professional research. They do not necessarily reflect the official policy or position of any affiliated institution, funder, agency, or that of the publisher. The authors are responsible for this article’s results, findings, and content.