Background
Methods
Study setting
Indicator | County A (Urban) | County B (Rural) | Country |
---|---|---|---|
Total | 4,463,000 | 985,000 | 45,371,000 |
Male | 2,237,000 (50.1%) | 466,000 (47.3%) | 22,393,000 (49.4%) |
Female | 2,226,000 (49.9 %) | 519,000 (52.7%) | 22,977,000 (50.6%) |
Population with any disability | 1.2% | 5.3% | 2.8% |
Morbidity | 19.2% | 33.2% | 21.5% |
Poverty rate | 16.7% | 33.8% | 36.1% |
Home deliveries for under 5 | 8.8% | 13% | 31.3% |
HDSS | |||
HDSS residents | 63,639 [31] | 255,000 [32] | |
Public | 161 | 123 | 4,929 |
Nongovernmental | 118 | 7 | 347 |
Faith-based | 100 | 16 | 1,081 |
Private | 543 | 28 | 3,797 |
Health Financing | |||
1,745 | 1,495 | 1,585 | |
Health insurance coverage (2015/2016) [26] | 40.7% | 7.6% | 19.0% |
Study design and data collection
Participant | Age | Type of disability | Highest level of education | Marital status | Source of income | Residence | Participant description |
---|---|---|---|---|---|---|---|
1 | 70 | mobility impaired | none | single | small-scale trading | urban | HDSS resident |
2 | 32 | mobility impaired | primary | single | laundering | urban | HDSS resident |
3 | 30 | mobility impaired | pre-school | married | none | urban | HDSS resident |
4 | 35 | visually impaired | secondary | separated | community health volunteer | urban | HISP beneficiary |
5 | 60 | mobility impaired | primary | divorced | small-scale trading | urban | HISP beneficiary |
6 | 57 | mobility impaired | primary | widowed | subsistence farming | rural | HDSS resident |
7 | 48 | mobility impaired | primary | married | subsistence farming | rural | HISP beneficiary |
8 | 24 | mobility impaired | none | married | small-scale trading | rural | HDSS resident |
9 | 77 | visually impaired | none | widowed | government cash transfer | rural | HISP beneficiary |
10 | 81 | visually impaired | none | widowed | government cash transfer | rural | HISP beneficiary |
11 | 58 | mobility impaired | primary | single | small-scale trading | rural | HISP beneficiary |
Data collection method | County A | County B | Total | ||
---|---|---|---|---|---|
HDSS | HISP | HDSS | HISP | ||
FGDs | 2 | 2 | 2 | 2 | 8 |
IDIs | 8 | 7 | 7 | 8 | 30 |
Conceptual framework
Data analysis
Results
Personal/individual factors
Women with disabilities living in poverty often opted to forgo seeking healthcare services they were entitled to under pro-poor health financing policies because of their roles in household provision and caregiving
“I usually say, if I go to the hospital, if I leave the market, how will the children eat? Personally, how will I eat? Just that! Because I don’t have anyone else who can help me…am just the way you are seeing me now”. Mobility impaired HISP beneficiary, County A
“Even if I decide to go to the hospital, there is no one left behind at home who knows that I have gone to the hospital so that they can help me feed the children…so I tell myself that if God knows that I am sick, I will get well.” Mobility impaired HISP beneficiary, County A
Diminished mobility and the need for assistance created multiple access barriers to healthcare services offered under pro-poor health financing policies
“It’s far [the nearest health center] but I have to walk because sometimes I don’t have money to take a motorbike. I will just “struggle” with my leg until I reach there. Even if I get tired, I will get there and the child will get treated…I walk slowly, I can’t walk fast, I can take even one hour to get there because if I walk fast I will injure myself. This metal… this caliper is big and it’s also heavy, so I can’t walk fast, I have to walk slowly”. Mobility impaired HDSS participant, County A
“Sometimes I get very sick and sometimes I don’t have money, will I ride in this wheelchair quickly to Hospital A? This road with the trailers and vehicles and I am in my wheelchair heading to Town A, I find it difficult, it’s not easy.” Mobility impaired HISP beneficiary, County B
“I go to the hospital in my wheelchair but I must get someone to help me…it takes me half an hour to get to the hospital because I ride [the wheelchair] slowly. Some people help me and others tell me “I have helped you several times, buy me “tea”. If I have KES 10, I give it to them….” Mobility impaired HISP beneficiary, County B
“What can prevent us from using this card [HISP]? If she gets sick and we have to go to the referral hospital, it becomes difficult to get there…Since she is blind, there must be someone to hold her from behind...from here to the referral hospital, its KES 200 for one person using a motorbike but since two people will go, I have to use KES 800 to and fro.” Caregiver of a visually impaired HISP beneficiary, County B
“It’s difficult to use public means of transport because they don’t like putting the wheelchair in the vehicle…. it wastes their time carrying it from the ground and putting it on top of the vehicle and then they will have to remove it, it’s difficult, sometimes they are in a hurry to go and transport people. They only agree if we are going long distances…if we are going to a place that costs KES 100 and above or KES 200 that’s when they allow us to board but if it’s a short distance they can’t agree”. Mobility impaired HISP beneficiary, County B
“The vehicles don’t stop; they refuse completely because assisting us to board is a challenge “Visually impaired HISP beneficiary, County A
“From here to hospital A they [abled people] pay KES 50 but I am transported [using a motorbike] with KES 100 to get to hospital A, to and fro KES 200…It makes me wonder if I am not a human being or what could be wrong with me? Even if you are walking along the road…when the motorbike riders find you they say “look at this “problem” in front of me, it wants to cause me trouble” while you were just standing by the roadside”. Mobility impaired HISP beneficiary, County B
“I was alone in the house and the hospital was far. The person who would have taken me to the hospital was not near but God helped me and I delivered without any problem. They found me when I had finished delivering”. Mobility impaired HDSS participant, County A
“This time around she went [to the ANC clinic]. The other times she didn’t go because there was no one to push her [wheelchair]. Right now she goes because her child pushes her [wheelchair]”. Mobility impaired HDSS participant, County B
Environmental factors
Disability unfriendly health facilities limited the extent to which women with disabilities living in poverty could benefit from healthcare services offered through pro-poor health financing policies
“Those who don’t talk, those with hearing impairment, you will find that the sign language interpreter maybe is not in the center or he/she is there but they are alone and maybe they are held up somewhere else. So there are those who have been complaining that they go to the hospital and they are not treated because maybe the sign language interpreter was not there that day”. Visually impaired HISP beneficiary, County A
“Sometimes you will get stranded even before you get to the doctor, you don’t know where you are and you don’t know where to start because you don’t have someone to guide you. So there should be someone to guide you so that you can get to the doctor.” Visually impaired HISP beneficiary, County A
“There are some places I use the wheelchair comfortably but there are other places that have stairs so I can’t use the wheelchair…the paths should be straight…. without stairs where one can fall over”. Mobility impaired HISP beneficiary, County B“There are no ramps…. I have to use the stairs and I am totally blind; I can’t move without someone to assist me”. Visually impaired HISP beneficiary, County A
“If I know am going to the hospital, I don’t drink anything that can make me want to go to the toilet because if I go to the toilet, I will have to leave my wheelchair at the door…the toilet doors are narrow…I don’t use the toilet until I get back home…the small wheelchairs they use in the hospital for patients can fit but I use a tricycle it’s a bit wide it can’t fit through the toilet door….we need toilets with a wide door, also when you enter the toilet seats shouldn’t be low, they should have high toilet seats so that if you enter the toilet you just sit on it and when you are through you go back to the wheelchair.” Mobility impaired HISP beneficiary, County B
“For sure those beds are not disability friendly…I suffered…I asked them if there was a way it could be pressed to come down so that I can climb onto the bed and then we lift it up again but it was difficult so I asked them about my friends with mobility disabilities, what do those on wheelchairs do... they said they have to carry them and lift them onto the bed”. Visually impaired HISP beneficiary, County A
Prejudice and negative attitudes by healthcare workers and other health system workers disempowered women with disabilities living in poverty and discouraged them from accessing the care they were entitled to under pro-poor health financing policies
“You can find a nurse asking you when you are having labor pains ‘How will I attend to you? where will I start, where will I finish?’ For example, I have a visual disability and also I have to be lifted to the bed first or be shown where the bed is and so forth….so you find, it’s like they don’t understand”. Visually impaired HISP beneficiary, County A
“Even if you tell the doctors to assist you with carrying water, they ask you “why don’t you tell your husband to carry for you, you are disturbing us, just stay there you will help yourself. I felt like they were looking down on me… I couldn’t be able to even open that pipe [urinary catheter] to drain the urine, discarding it was also a problem”. Mobility impaired HDSS participant, County B
“They [healthcare workers] told her it’s not good for her to give birth and it’s not good for her to have sex. Because she has a problem with her legs it’s not good to have sex with men, it’s not good for her to give birth.” Mobility impaired HDSS participant, County B
“They feel we don’t have a right to get children. I also have a friend [with a disability] who went to the antenatal clinic and she was asked “even you?” Visually impaired HISP beneficiary, County A
“When I went to deliver, the healthcare workers don’t view you as a person who needs their help. No! you face difficulties all by yourself, it’s even hard for them to attend to you…. I told myself if I continued to give birth, I would die.” Mobility impaired HISP beneficiary, County A
“I tell myself, disabled people don’t have someone who will serve them quickly. Even if I go to the hospital, they won’t attend to me, I just stay at home” Mobility impaired HISP beneficiary, County A
“I feel that the healthcare worker is mistreating me because I am disabled, so overall, we [women with disabilities] don’t like speaking up”. Mobility impaired HDSS participant, County B
“Even if I get there [health center] at whatever time…they will have mercy on me and treat my child…there is a day my child was sick and I got there when they were closing. So they looked at how I was and they said “let’s help her so that she doesn’t go back with the sick child. She walks slowly and she can’t get here quickly.” So those who were there remained behind and they helped me. The government health center helps even a disabled person like me…They will help me because they know am not able. I can’t go to these private ones because they won’t help me, they want money”. Mobility impaired HDSS participant, County A