Doctoral Degrees (SSD)

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    Equitable access to healthcare services for people with disability in the regions of Khomas and Kunene
    (University of Namibia, 2018) Van Rooy, Gert
    This dissertation investigated equitable access to healthcare services for people with disabilities in selected health facilities in both the Khomas and Kunene regions of Namibia. The research question guiding the analysis was based on factors that hamper equitable access to health care for people with and without disability. This was done by addressing some contextual and personal factors within the parameters of the International Classification of Functional Disability and Health (ICF) model with a specific intention to establish if those factors inhibit access to healthcare. The mixed approach was used for data collection. A thematic analysis was used for the qualitative data collection, while household surveys were used, based on the themes that emerged from the qualitative data, for the quantitative approach. Participants of the study were drawn from health care facilities of selected clinics in the catchment area (the Khomas and Kunene regions). Each of the 947 cases included an individual with a disability and an individual with no disability, referred to as the control. By using the equitable framework (based on the ICF model), for analysis, the findings of the dissertation indicate that there are no major problems for vulnerable groups in receiving healthcare, since everyone had access to it, instead access to health care is limited by some major barriers for some people with disabilities (PWD). On the other hand, not only are PWD faced with barriers, they also experience activity limitation, in seeing, hearing, walking, remembering, self-care and communication, factors that are treated as independent variables in this study. Of these factors, seeing was recorded as the main barrier for those PWD who had ‘some difficulty’ (36.1%) or ‘a lot of difficulty’ (22.6%). In terms of dependent variables, ‘lack of transport from home to the healthcare facility’ scored the highest in Kunene, followed by ‘affordability of transport’. ‘Negative attitudes of healthcare workers’, ‘standard of healthcare facility’, and ‘inadequacy of drugs and equipment at healthcare facility’ were also among the ‘serious/insurmountable’ problems cited by PWD in the Kunene region. PWD also reported satisfaction with the time spent waiting, confidentiality and knowledge of healthcare providers at the health care facilities. In conclusion, the combination of many factors (contextual and personal) as per the ICF model, created barriers to accessing healthcare services. These could be too challenging to overcome, even with well-functioning, locally-based healthcare services in a given area. The availability of good healthcare tends to vary inversely with the population it serves. The study presents a modified access barriers and satisfaction model that support vertical equity for PWD. This was because PWD did have greater health care needs when they visited the health care facilities.