Socio-demographic information
The background information of the participants is presented in Table 1. More than half of the student participants, 53.8% and 66.7%, from the School for the Blind and Special Vocational School were males (see Table 1). The minimum age of the student participants across all the schools was 18 years, but the maximum age varies in all the schools (see Table 1). More than half of health workers, 52.9% were females. The minimum years of working experience was 5 years, whilst the maximum years was 13 years. Also, all the school mother participants were females, with a minimum age of 28 years and the maximum age of 54 years.
Table 1 Background information
|
Frequency
|
Percentage (%)
|
Students with disabilities
|
|
|
School for the Blind (n=13)
|
|
|
Gender
Male
Female
|
7
6
|
53.8
46.2
|
Age
18-20 years
21-25 years
26-30 years
31 years and above
|
4
1
5
3
|
30.8
7.7
38.5
23.1
|
School for the Deaf (n=11)
|
|
|
Gender
Male
Female
|
5
6
|
45.5
54.5
|
Age
18-20 years
21-25 years
|
4
7
|
36.2
63.6
|
Special Vocational School (n=6)
|
|
|
Gender
Male
Female
|
4
2
|
66.7
33.3
|
Age
18-20 years
21-25 years
26-30 years
|
2
3
1
|
33.3
50.0
16.7
|
Health workers (n=17)
|
|
|
Health workers participants
Nurses
Doctors
|
12
5
|
70.6
38.5
|
Gender
Males
Females
|
8
9
|
47.1
52.9
|
Work experience
Minimum/Maximum
|
5/13
|
|
School mothers (n=8)
|
|
|
Gender
Females
Males
|
8
-
|
100
-
|
Age
Minimum/Maximum
|
28/54
|
|
Education
Junior High School
Senior High School
Tertiary
|
2
3
3
|
25.0
37.5
37.5
|
Work experience
Minimum/Maximum
|
12/22
|
|
Themes that emerged from the analysis
The study identified three global and seven organizing themes. Global and organizing themes were used to organize the results (see Table 2). The themes were consistent across the student, health professional and school-mother participants. The thematic analysis identified a convergent or similar view from participants regarding the accessibility of health care to students with disabilities. This is because all the participants had a common goal towards the health and well-being of students with disabilities.
Table 2 Themes emerging from the analysis
Global themes
|
Organizing themes
|
Basic themes
|
Codes
|
Theme 1: Accessibility of health care
|
Physical environment of health facilities
|
Unfriendly physical environment
|
- Poor road network
- Poor hospital environment
|
Physical structure of health facilities
|
Inaccessible physical structure
|
- Hospital doors
- Hospital building
- Staircase
- Overcrowded tables and chairs
- Medical tables and chairs
- Staircases
- Walkways
- Unreachable consulting rooms
- Malfunctioning lift
|
Equipment and logistics
|
- Inaccessible equipment and logistics
|
- Directional signs
- No tactile or braille
|
|
- Available equipment and logistics
|
- Limited medical equipment
|
Theme 2: Adequacy of health care
|
Support services
|
|
- No support services
- Limited preferential treatment
|
Availability of sign language interpreters
|
- Lack of sign language interpreters
|
- No sign language interpreters
- Communication difficulties
- No knowledge of sign language
- Miscommunication
|
|
- Limited Sign language support
|
- School-mothers ability to sign
|
Theme 3: Affordability of health care
|
Source of financing health care
|
- Unreliable financing sources
|
- Personal funds
- Family members
- Individual supports
- School authority
- Social welfare services
- National Health Insurance Scheme
|
Challenges in financing health care for students with disabilities
|
- Setbacks in health financing care
|
- Difficulty in obtaining consultation records
- Limited benefit coverage of NHIS
- Less expensive drug
|
Theme 1: Accessibility of health care
Physical environment of health facilities
Most participants (students, school mothers and health workers) noted that the physical environments of health facilities were unfriendly to accommodate students with disabilities. The challenges associated with the physical environments were poor road network leading to health facilities, bushy nature of the roads and the immediate hospital environment. Specifically, some participants (students, school mothers and health workers) mentioned that the roads leading to health facilities were untarred, and had open gutters. Some of the participants felt that the poor roads and gutters usually serve as a trap, particularly for students with visual impairments:
“There are many challenges with the covers on the gutters along the road. The road is not corresponding to the gutters. The gutters are not well covered. Covers connecting the entrance of the hospital are not well cemented, so I have to drag my legs in the pebbles to picture it before I get there” (Student IDIs, participant 13).
Most participants (students, school mothers and health workers) further expressed that the paths leading to the hospitals were too narrow. This makes movement extremely difficult for students with disabilities, particularly when there is no sighted guide or family caregiver accompanying them to the facility. Besides, school mothers from the selected schools confirmed that the roads leading to health facilities were unfriendly to accommodate students with disabilities.
Physical structure of health facilities
The majority of the participants (students and school mothers) had a mixture of feelings about the physical structure of health facilities. Some participants (students, school mothers) noted that the physical structure of health facilities were unfriendly to accommodate students with disabilities. Some participants particularly those with visual impairment felt that they had some difficulty accessing the hospital doors. For instance, some students with visual impairments narrated that the doors were made of sliding glass, but were mostly not open to facilitate their movement:
“For the blind to access that place, you have to use your hand to locate where the door is, to know if it’s opened or closed. So if it’s opened you just access how big or wide the door is, then you go through” (Student IDIs, participant 22).
Most participants (students and school mothers) further expressed that there were several obstacles when moving inside the hospital building. Some of the students narrated that the challenges they faced were unfriendly staircase. For instance, the students said there were a lot of staircases in the hospital environment. An unfriendly staircases made it difficult for students with disabilities when walking to and from the consulting rooms and other departments within the health facility:
“When accessing the Out-Patient Department, I have to climb some stairs, and climbing the stairs is difficult. If you are not careful and the ground is slippery you can easily fall” (Student IDIs, participant 2)
Some student participants further expressed that there were overcrowded tables and chairs as well as unadjusted medical tables and chairs to meet their needs. Some participants (students with visual impairment) also mentioned that patients without disabilities mostly stood in their walk-ways:
“One of them is that there are a lot of people in the hospital so some people will be standing in your way not knowing that you are blind and they expect you to see them and swerve them, which I do bump into them. And on the way to the laboratory at the Government Hospital, there are some glasses, going through is difficult at times” (Student IDIs, participant 16).
Moreover, some participants also expressed that washrooms and toilet facilities in some health facilities were unfriendly to accommodate students with disabilities:
“and their washrooms are not in a good shape, in that I have to go to a nearby bush to ease myself anytime I visit the hospital” (Student IDIs, participant 9).
Most health professional participants also confirmed that the health facilities were unfriendly to accommodate students with disabilities, particularly those with visual and physical impairments. Some health professionals noted that students with physical and visual impairments were having difficulty moving around the hospital building:
“For me honestly, I think the hospital was purposely made not disability friendly. When you go to the Wards, there are some stairs that ideally, it shouldn’t have been there. The washroom has no rails to aid or support the students with disabilities who visit the hospital” (Health Professional, participant 1)
The experiences of students with disabilities towards the physical structure of health facilities confirm that of the health professionals. For instance, most of the health professionals noted that the consulting rooms of some health facilities were located on a story building, however, the available lift was not always functioning to support students with disabilities. This makes it difficult for students with disabilities, particularly those with visual impairment to access the consulting rooms.
Equipment and logistics
The participants shared their experiences regarding the accessibility nature of the existing equipment and logistics in the health facilities. The majority of the participants (students, school mothers) expressed that students with disabilities faced several challenges due to unfriendly equipment and inadequate logistics to support the delivery of accessible health care. Some participants felt that there were no directional signs to support the movement of students with disabilities when accessing health care. Again, the few directional signs were not usually accessible particularly for students with visual impairment. Also, the majority of participants (students, school mothers and health professionals) expressed that there were no tactile or braille to support patients with visual disabilities when accessing health care. This difficulty was also confirmed by one health professional when he stated that” “There is no tactile system for visually impaired. Those that are in the hospital are not meant for the disabled” (Health Professional, participant 1).
Although most participants expressed that some health facilities had limited and inaccessible equipment and logistics to support students with disabilities, few health professionals recounted that some equipment and logistics were available to support such patients. For instance, the available equipment was wheelchairs to convey students with disabilities in the hospital. Besides, some health professionals mentioned that students with disabilities particularly those with visual disabilities were given lenses, canes, clutches and stretches to aid their movement in the hospital.
Theme 2: Adequacy of health care
Limited support services
This section explored the adequacy of health care to students with disabilities. Here, the participants narrated some of the support services that facilitate access to health care to students with disabilities. In a typical health care practice, students with disabilities (similar to those without disabilities) present to the hospital and give out details of their identity document to the outpatient departments. The outpatient department identifies the medical consultation records of the patients. The nurses then initiate the care and refer the patient to the appropriate medical doctor. The nurses carry the medical consultation records to the consulting rooms on behalf of the patients. Regarding the care, most of the participants expressed that students with disabilities did not receive any special support services. For instance, some participants noted that they had to join the usual queue for hours whenever they visited the outpatients’ services (for instance, getting their medical consultation records):
“You have to join a queue, and they don’t even consider the fact that you are impaired. There was an instant where I had to stand for about two hours because the seats were full” (Student IDIs, participant 3).
“I have familiarized myself with the environment, so I take off those errands by myself by getting my card (consultation records) at the Out-Patient Department (OPD)t. No special support for me” (Student IDIs, participant 7)
The school-mothers also recounted that there were no special support services provided to students with disabilities when accessing health care. For instance, some school-mothers noted that they experience difficulties when trying to get consultation records (that contain medical history) for students with disabilities at the Out-Patient Department:
”I put the child on my back and quickly rush to the OPD and get the card (consultation records). At the OPD, the nurses don’t help at all. Unless it is an emergency, but if you go and tell them that O’ Nurse this is a special child, none will help you to process the card (consultation records) or even give you preferential treatment (School-mother, participant 3)
Lack of sign language interpreters
The majority of participants believed that sign language interpreters were valuable in supporting students with hearing disabilities. However, most participants (students, school mothers and health workers) expressed that there were no sign language interpreters in most of the health facilities to support students with hearing disabilities. The participants noted that the lack of sign language interpreters were creating several barriers for students with disabilities. For instance, some participants felt that the absence of sign language interpreters created communication difficulties and subsequently led to miscommunication between patients and health professionals. Some participants expressed that the lack of sign language interpreters sometimes, leads to misinterpretation of the symptoms of illness:
“I wish they (sign language interpreters) were there because I could have communicated very well since they understand my language and also, I understand theirs. Their absence has caused me a lot, because at times I have to write, which at times I cannot spell the words” (Student IDIs, participant 19).
“No interpreters, due to that I have to write and other times I have to go with my parents. Sometimes my writing is not clear to the doctors, and I observed that the doctors are just guessing” (Student IDIs, participant 23)
The health professionals also expressed that understanding sign language is necessary to facilitate the service delivery, however, they did not know how to sign with students with hearing disabilities. Practically, the lack of knowledge in signing affect how they interpreted students’ diagnosis and illness:
‘Sign language interpretation is very important, you know we are taking care of a lot of people including those who are deaf and dumb so it will help. Else you can give different diagnosis’ (Health Professional, 6)
Although school-mothers were able to sign and also interpret sign language, the health professionals were deficient in the sign language and its interpretation. This could have a serious consequence on the delivery of health care, particularly to students with hearing disabilities
Theme 3: Affordability of health care
Sources of financing health care
The sources of financing health care is relevant to improve access to health care to students with disabilities. Most participants (students and school mothers) mentioned several sources of financing health care. The students with disabilities financed their health care through personal funds, family members (fathers, mothers, siblings, uncles, aunties and other relatives), individual supports (cooperate entities and individuals), school authority, social workers and National Health Insurance Scheme (NHIS). Most health professional participants recounted that students with disabilities, sometimes, experience difficulty paying for the cost of their health care. This was echoed as follows:
“Some of the students with disabilities are not able to pay for their bills. Some of them have to beg other patients to foot their bills and sometimes we the nurses have to dip our hands into our pocket” (Health professional, participant 1)
Although some students with disabilities expressed difficulty in paying for the cost of health care, the health professional participants recounted that there were social welfare services in some health facilities to support students who were unable to pay for their health care expenditure:
“We have the Social Welfare Department in the hospital. They screen persons who put themselves up not to be able to pay their bills” (Health professional, participant 1)
Challenges in financing health care for students with disabilities
The participants described some of the challenges associated with the sources of financing health care for students with disabilities. The challenges regarding the sources of financing health care were largely associated with the NHIS. The majority of participants narrated that whilst most students with disabilities were active members of the NHIS, they encountered several difficulties, which include limited benefits and difficulty in obtaining consultation records from the OPD:
“Acquiring the card (consultation records) is tedious because the process is long. With long queues, where they end up telling you they have a quota they will attend to, leaving the rest” (Student IDIs, participant 5).
The NHIS appears as a sustainable source of financing health care, yet some mentioned that the scheme had limited benefit coverage and less expensive drugs. Some student participants echoed this as follows:
“Sometimes you go there and they will tell you the drug they are given you isn’t covered by the NHIS, so you have to go and buy it elsewhere” (Student IDIs, participant 12).
“The challenge is that you do not get the best drugs, those you get are just some cheap drugs. You even have to buy some in addition” (Student IDIs, participant 14).
“There are a lot of challenges because when you hold the NHIS card (consultation records), they provide you with drugs of less cost and ask you to go buy those that are expensive” (Student IDIs, participant 4)
The narrations from the student participants were consistent with the challenges expressed by the school mothers regarding the NHIS. For example, some school mothers mentioned that the NHIS benefits were unable to cover some drugs and medications for students, particularly those with intellectual disabilities:
“Sometimes the medicine to be given is expensive and because you are using the NHIS card (consultation records) they will say that kind of medicine is not available. But, the truth is some will be there. So sometimes when I go I tell them, madam, please if there is some available I am buying it. Because, I am a school-mother and I can’t go and join the queue in a different Drug-store where I would not get” (School-mother, participant 3)
The analysis implies that the challenges associated with using NHIS could discourage students with disabilities from relying on this source of financing health care. Consequently, students with disabilities may have limited access to health care, which could be associated with their previous experience from the NHIS.