Over the last two decades the South African government has passed several pieces of legislation to ensure that people with disabilities are included in society and are able to access services such as health care.
This has included a national disability grant as well as regulations that all government buildings provide ramps so that people with disabilities can easily access them.
According to official statistics 7.5% of South Africans live with disability. In the rest of the world, this figure sits at 15%. It’s quite possible that the South African figure doesn’t reflect the full extent of disability in the country because of under-reporting.
Global studies show that the top three barriers stopping people with disabilities from using health facilities are cost, lack of services near to where they live and transportation.
Our study found that these three barriers were particularly acute for poor people with disabilities living in rural South Africa. This is because they experience a “triple vulnerability”: poverty, disability and rurality. They see themselves as less healthy compared to able bodied people and they have less access to health care.
A community with very little
Our study formed part of the international study Equitable. This looked at access to health care for people with disabilities, evaluating 16 sites in South Africa, Namibia, Malawi and Sudan.
Our part of the study centred on Madwaleni in the Eastern Cape, a largely rural and poor province in South Africa. We looked at the differences between people with and without disabilities when it came to accessing health care.
Madwaleni is made up of about 20 villages scattered around rugged hills, valleys, rivers and forests. The area lacks basic services like water and electricity and has poor infrastructure. Nearly 90% of the community is unemployed and there are low levels of literacy and education. There is a high incidence of communicable diseases and high mortality rates.
There is a hospital which handles cases in a 35km radius as well as eight smaller health care centres. Together they service the 120 000 people living in the area.
Poor people with disabilities have more problems going about their daily activities than those who are able bodied. Travelling around their communities, shopping, preparing food and doing household chores are more challenging. They also have problems furthering their education and getting jobs and often experience prejudice and discrimination.
In a rural, remote and impoverished communities these challenges are more amplified. The people with disabilities in these settings experience such issues more intensely.
In Madwaleni the topography of the area, the natural environment and the terrain all contribute to the experiences of people with disabilities. Many have to manage hills, cross rivers or use gravel and uneven roads to access health care.
The distances are vast between the eight smaller health centres and the villages in the area. Travelling on foot is often not an option and taxis are expensive. The result is that people with disabilities receive health care less often and in turn feel that they have poorer physical and mental health.
In addition to transportation problems, there are other physical barriers. For example, participants recounted how they were unable to use overnight accommodation at health care centres and were not provided with the drugs and equipment they needed after their consultations.
In addition to these challenges, participants said they encountered negative attitudes from health care providers who treated them differently from other patients.
People with disabilities felt their preferred health care providers were not as accessible to them as their able bodied peers. They also did not receive the same level of service and were unhappy with health care personnel.
They communicated less with health care providers and as a result felt that they received less respect from these providers. This often meant that they were afforded less privacy during consultations when compared with able bodied patients. This meant that health care providers did not spend time explaining things to them. They also felt that they were less involved in their own treatment.
Improving the situation
Based on the site study in Madwaleni, there are several changes that could improve the way rural people with disabilities access health care.
Mobile health clinics would help. This would mean that people with disabilities could access health care services more regularly.
In addition, health care workers should be trained to better deal with people with disabilities so that attitudinal barriers can be addressed.
And lastly, the community needs to be educated about disability and how it can help create a more inclusive environment.