Disability-friendly healthcare at public health facilities in Bangladesh: a mixed-method study to explore the existing situation

• Published in: BMC health services research Vol. 22; no. 1; pp. 1 - 1178
• Main Authors: Torsha, Nawshin, Rahman, Farah Naz, Hossain, Md Shafkat, Chowdhury, Hasina Akhter, Kim, Minjoon, Rahman, S. M. Mustafizur, Rahman, A. K. M. Fazlur, Rahman, Aminur
• Format: Journal Article
• Language: English
• Published: London BioMed Central Ltd 20-09-2022; BioMed Central; BMC
• Subjects: Access for the disabled; Access to information; Anthropology; Bangladesh; Care and treatment; Caregivers; Communication; Community; Disability; Disability friendly healthcare; Focus groups; Handicapped accessibility; Health aspects; Health care; Health facilities; Health service; Health services; Hospitals; Infrastructure; Mixed methods research; People or persons with disability; People with disabilities; Physically disabled persons; Polls & surveys; Public health; Public healthcare facilities; Safety and security measures; Social aspects; Bangladesh; Ireland
• ISSN: 1472-6963; 1472-6963
• DOI: 10.1186/s12913-022-08538-6

Abstract
Background
Several strategies and policies are being implemented in Bangladesh to address the healthcare needs of people with disabilities, who comprise about 10% of the country’s total population. However, these measures are not adequate to provide accessible or friendly healthcare to the people with disabilities. This study aimed to explore the disability-friendliness of healthcare facilities, and the challenges of people with disabilities in terms of access to 1) information and communication, 2) access to infrastructure, and 3) providers’ capacity in Bangladesh.
Methods
An explanatory sequential mixed-method study was conducted, including a cross-sectional survey of healthcare facilities, followed by structured-interview with people with disabilities and healthcare managers, and qualitative interviews among people with disabilities or their caregivers, healthcare providers (HCPs), policymakers, and community leaders. Data were collected from 150 public healthcare (primary-to-tertiary) facilities and from 300 people with disabilities in 16 districts across Bangladesh between January-December 2019. An observational checklist and structured questionnaires were used to assess the situation of healthcare facilities, and literature-guided guidelines were used for qualitative interviews. During analysis, the disability-friendliness of healthcare facilities were quantified through a scoring system, and thematic analysis of qualitative data was performed to identify the challenges of implementing disability-friendly healthcare (DFHC).
Results
The score for providing DFHC was low across all the four objectives in the healthcare facilities. The highest score (mean percentage) was observed in the infrastructure domain: 29.3 ± 20.5, followed by communication: 18.2 ± 4.8, and information: 14.6 ± 6.22, and the lowest (0.93 ± 7.1) score was for capacity of the HCPs to provide DFHC. Mean percentage scores for access to 13 infrastructure points were low, and extremely low scores were found in areas such as access to elevators (5.6 ± 5.0), ticket counters (7.3 ± 17.7) and toilets (10.6 ± 9.3). Furthermore, about 59.1% of people with disabilities expressed dissatisfaction regarding access to information and communication. The majority (98.2%) recommended that training of HCPs can improve the situation.
Conclusion
This study revealed that most of the public health facilities in Bangladesh were not disability-friendly. Findings can inform development of a national disability-friendly policy with implementation guidelines.