Access to Primary Health Care Services for Persons with Physical Disabilities in Rural Ghana
Background: A growing body of evidence has shown that persons with physical disabilities experience substantial barriers in accessing primary health care (PHC) services in rural areas. Negative attitudes from health care providers and inaccessible health care facilities and equipment are common experiences that negatively affect access to quality health care for persons with physical disabilities. However, there is limited research that explores this issue in rural Ghana. Objective: I carried out this dissertation in three chapters to address this research gap. Chapter 3 synthesized published literature to understand the factors affecting access to PHC for persons with disabilities (PWDs) in rural areas globally. Chapter 4 explored the experiences of persons with physical disabilities in accessing PHC services in rural Ghana. Chapter 5 highlighted the perspectives of health care providers in delivering PHC services to persons with physical disabilities in rural Ghana. Method: I employed framework synthesis and used framework analyses to analyze existing literature (chapter 3). I also used a qualitative descriptive design to conduct semi-structured interviews with 18 persons with physical disabilities (chapter 4) and 15 health care providers (chapter 5). I used thematic analysis to guide the analysis of the interviews. Results: In chapter 3, I found that PWDs were unable to access PHC due to obstacles including the interplay of four major factors; availability, acceptability, geography and affordability. Chapter 4 revealed that participants shared their experiences under two overarching themes: limited facilities and lack of providers. Chapter 5 uncovered three major themes: challenges in providing health care; strategies in navigating the challenges; and positive experiences in providing health care. Implications: The information provided in this dissertation is potentially important to policy makers and PHC providers as it presents evidence on the barriers and facilitators to PHC access in rural settings. In particular, understanding this topic from multiple sources (existing literature, PWDs and providers) will be critical for policy design and client-centered service delivery in rural Ghana and potentially other low- and middle-income countries.