ASSESSING BARRIERS TO HEALTHCARE FOR PERSONS WITH DISABILITIES IN SOUTH SUDAN

E. Nakamura^1,2, R. Anguyo¹, B. Devkota¹, C. Jeffery¹, J.J. Valadez¹

¹Liverpool School of Tropical Medicine, International Public Health, Liverpool, United Kingdom, ²Save the Children Japan, International Programs, Tokyo, Japan

Background: Persons with disabilities (PWDs) are hindered from accessing healthcare by various barriers, especially in low-income settings. Despite the more challenging access to healthcare in low-income countries and humanitarian settings, reliable data on barriers in these vulnerable areas are very limited. The South Sudan National Household Health Survey of 2020 found a prevalence of disability of 25.7% (95% CI: ±2.4) among those aged two to 49 years; 56.8% of PWDs had limited access to healthcare. However, the types of barriers faced by PWDs in accessing healthcare are not clear. Access to healthcare is a basic right no matter where you live, and identifying the barriers faced by PWDs is crucial to help achieve a society in which no one is left behind.

Purpose: To identify the main barriers faced by PWDs in South Sudan in accessing healthcare and their specific risk factors.

Methods: This is a secondary analysis of the 2020 National Household Health Survey. The survey used stratified random sampling with the Lot Quality Assurance Sampling (LQAS) approach with interviews in randomly selected households. The type of disability was assessed using the Washington Group Short Set on Functioning (WG-SS). The survey covered 81 counties, 10 states and three Administrative Areas. Of the 534 PWDs, 200 samples without access to healthcare were used for analysis. The inclusion criteria were PWDs aged two years or older. Remembering, self-care and communication difficulties were excluded in children <5-years of age because they were too immature to assess. Rate ratios (RR) were calculated and risk factors were assessed.

Results: The five major barriers faced by PWDs were found; long distances, service fees, travel times, lack of information about where to go and lack of medicine. A risk factor of long distance was living in the Greater Upper Nile region (RR 1.763, p=0.036) and a risk factor of services fees was living in the Bahr el Ghazal region (RR 3.942, p=0.005). People with severe disabilities were a risk factor, increasing the likelihood of travel time (RR 1.997, p=0.011) and lack of information about where to go (RR 2.045, p=0.016). Being a female was more at risk of experiencing a lack of medicine (RR 1.707 p=0.045).

Conclusions: Many barriers were similar to those reported in previous studies in low-income sub-Saharan Africa and humanitarian environments. The main risk factors for each barrier were region, degree of disability and sex. Due to the small sample size, only simple regression analysis was possible. Further studies with large sample sizes are needed to identify confounder-controlled risk factors using multiple regression analysis.

Implications: The findings of this study could serve as baseline data for South Sudan and other sub-Saharan African countries and post-conflict areas, and will be useful in determining action guidelines and evaluating the effectiveness of interventions.

Funding acknowledgements: Rotary International's Global Scholarship provided financial support.

Keywords:
Barriers to healthcare
Persons with disabilities
South Sudan

Topics:
Disability & rehabilitation
Primary health care
Globalisation: health systems, policies & strategies

Did this work require ethics approval? No

Reason: This is a desk-based study using existing data; thus, it does not need ethical approval. However, all processes during this secondary analysis were implemented based on ethical standards maintained. The original data were reviewed and approved by Ethical Review Committees at Liverpool School of Tropical Medicine (LSTM) and the Ministry of Health of South Sudan. The use of the original data for secondary analysis has been submitted to the LSTM Research Ethics Committee.