Access to health care for persons with disabilities in Madwaleni, Eastern Cape, South Africa

Thesis (PhD)--Stellenbosch University, 2016ENGLISH ABSTRACT : Global research suggests that persons with disabilities face barriers when accessing health care services. Yet, information regarding the nature of these barriers, especially in low-income and middle-income countries is sparse. Rural contexts in these countries may present greater barriers than urban contexts, but little is known about access issues in such contexts. There is a paucity of research in South Africa looking at “triple vulnerability” – poverty, disability and rurality. The current study provides a local case study of these issues with the aim of informing future interventions to improve the lives of persons with disabilities. This study explores the challenges faced by persons with disabilities in day-to-day living and in accessing health care in Madwaleni, a poor rural isiXhosa-speaking community in South Africa. The study includes a quantitative survey with interviews with 773 participants in 527 households. Comparisons between persons with disabilities and persons with no disabilities were explored. Results suggest that persons with disabilities in Madwaleni generally experience more problems in terms of daily living as well as health issues (including access to health care) compared to persons with no disabilities. In terms of access to health care there were primarily three types of barriers – physical barriers, attitudinal barriers and communication barriers – for persons with disabilities in Madwaleni. Persons without disabilities living in households with persons with disabilities did not, however, experience more barriers to health care than did those in households without disabilities. Implications and recommendations for the future are discussed in order to make some concrete and practical solutions in the area of disability in Madwaleni.AFRIKAANSE OPSOMMING : Wêreldwye navorsing dui daarop dat persone met gestremdhede hindernisse in die gesig staar wanneer hulle poog om toegang tot gesondheidsorgdienste te verkry. Desnieteenstaande is inligting rakende die aard van hierdie hindernisse, veral in lae- en middel-inkomste lande, skaars. Landelike omgewings in hierdie lande mag moontlik groter hindernisse daarstel as stedelike omgewings, maar daar is min kennis oor toegangskwessies in sulke omgewings. Daar is ‘n tekort aan navorsing wat die “driedubbelde kwesbaarheid” – armoede, gestremdheid en landelikheid – in Suid-Afrika ondersoek. Die meegaande studie verskaf ‘n plaaslike gevallestudie rakende hierdie kwessies, wat ten doel het om toekomstige intervensies toe te lig ten einde die lewens van persone met gestremdhede te verbeter. Hierdie studie verken die uitdagings wat persone met gestremdhede in hul daaglikse bestaan en in die verkryging van toegang tot gesondheidsorg in Madwaleni, ‘n arm, landelike isiXhosa-sprekende gemeenskap in Suid-Afrika, in die gesig staar. Die studie sluit ‘n kwantitatiewe opname met onderhoude met 773 deelnemers in 527 huishoudings in. Vergelykings tussen persone met gestremdhede en persone sonder gestremdhede is verken. Resultate dui daarop dat persone met gestremdhede in Madwaleni oor die algemeen meer probleme in hul daaglikse bestaan sowel as met gesondheidsorgkwessies (insluitend toegang tot gesondheidsorg) ervaar as persone sonder gestremdhede. Wat toegang tot gesondheidsorg aanbetref, was daar vir persone met gestremdhede in Madwaleni hoofsaaklik drie tipes hindernisse – fisiese hindernisse, houdingshindernisse en kommunikasie hindernisse. Persone sonder gestremdhede, wat in huishoudings met persone met gestremdhede leef, het egter nie. Implikasies en aanbevelings vir die toekoms word bespreek ten einde konkrete en praktiese oplossings op die gebied van gestremdheid in Madwaleni te bied