Original Research

A path toward disability-inclusive health in Zimbabwe Part 2: A qualitative study on the national response to COVID-19

Tracey Smythe, Thubelihle Mabhena, Shepherd Murahwi, Tapiwanashe Kujinga, Hannah Kuper, Simbarashe Rusakaniko
African Journal of Disability | Vol 11 | a991 | DOI: https://doi.org/10.4102/ajod.v11i0.991 | © 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 and 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 and Tropical Medicine, London, United Kingdom
Simbarashe Rusakaniko, Department of Community Medicine, University of Zimbabwe, Zimbabwe


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Abstract

Background: People with disabilities are at higher risk of adverse coronavirus disease 2019 (COVID-19) outcomes. Additionally, measures to mitigate COVID-19 transmission have impacted health service provision and access, which may particularly disadvantage people with disabilities.

Objectives: To explore the perspectives and experiences of people with disabilities in accessing health services in Zimbabwe during the pandemic, to identify perceived challenges and facilitators to inclusive health and key actions to improve accessibility.

Methods: We used in-depth interviews with 24 people with disabilities (identified through purposive sampling) and with 10 key informants (from expert recommendation) to explore the impact of COVID-19 on access to health care. Interviews were transcribed, coded and thematically analysed. We used the disability-inclusive health ‘Missing Billion’ framework to map and inform barriers to inclusive health care during COVID-19 and disparities in outcomes faced by people with disabilities.

Results: People with disabilities demonstrated good awareness of COVID-19 mitigation strategies, but faced difficulties accessing COVID-19 information and health services. Challenges to the implementation of COVID-19 guidelines related to a person’s functional impairment and financial ability to do so. A key supply-side constraint was the perceived de-prioritisation of rehabilitation services. Further restrictions on access to health services and rehabilitation decreased an individual’s functional ability and exacerbated pre-existing conditions.

Conclusion: The immediate health and financial impacts of the COVID-19 pandemic on people with disabilities in Zimbabwe were severe. Government departments should include people with disabilities in all communications and activities related to the pandemic through a twin-track approach, meaning inclusion in mainstream activities and targeting with specific interventions where necessary.


Keywords

disability; COVID-19; Zimbabwe; qualitative; equity; Missing Billion; inclusion; health system; health access

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