Original Research

A path toward disability-inclusive health in Zimbabwe Part 1: A qualitative study on access to healthcare

Tracey Smythe, Thubelihle Mabhena, Shepherd Murahwi, Tapiwanashe Kujinga, Hannah Kuper, Simbarashe Rusakaniko
African Journal of Disability | Vol 11 | a990 | DOI: https://doi.org/10.4102/ajod.v11i0.990 | © 2022 Tracey Smythe, Thubelihle Mabhena, Shepherd Murahwi, Tapiwanashe Kujinga, Hannah Kuper, Simbarashe Rusakaniko | This work is licensed under CC Attribution 4.0
Submitted: 29 November 2021 | Published: 30 May 2022

About the author(s)

Tracey Smythe, Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom
Thubelihle Mabhena, Pan African Treatment Access Movement, Harare, Zimbabwe
Shepherd Murahwi, Leonard Cheshire Disability Zimbabwe, Harare, Zimbabwe
Tapiwanashe Kujinga, Pan African Treatment Access Movement, Harare, Zimbabwe
Hannah Kuper, Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom
Simbarashe Rusakaniko, Department of Community Medicine, University of Zimbabwe, Zimbabwe


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Abstract

Background: On average, people with disabilities have greater healthcare needs, yet face a range of barriers in accessing care.

Objectives: Our objectives were to explore the experiences of people with disabilities in accessing care and identify opportunities for the health system to be designed for inclusion in Zimbabwe.

Methods: In-depth qualitative interviews were conducted between May and June 2021 with 24 people with disabilities (identified through purposive sampling) and with 10 key informants from local and national health authorities (identified through expert recommendations). Interviews explored the experience of accessing healthcare prior to the coronavirus disease 2019 (COVID-19) pandemic. Interviews were transcribed, coded and thematically analysed. We used the disability-inclusive health ‘Missing Billion’ framework to map and inform barriers to inclusive healthcare and disparities in outcomes faced by people with disabilities.

Results: People with disabilities experienced difficulties accessing health services in Zimbabwe prior to COVID-19. These experiences were shaped by health literacy, self-stigma and affordability of services, which limited demand. Supply of health services was constrained by the perceived poor capacity of health workers to treat people with disabilities and discrimination. Inclusion was facilitated by clinic staff support of people with disabilities’ access to medication through referral to mission hospitals and private clinics, and the lobbying of organisations of people with disabilities.

Conclusion: Strategies to promote disability inclusion in healthcare include meaningfully engaging people with disabilities, investing in organisations of people with disabilities, protecting funding for disability inclusion, collecting and analysing disability-disaggregated data and strengthening a twin-track approach to health service provision.


Keywords

disability; Zimbabwe; qualitative; equity; Missing Billion; inclusion; health system; health access

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