People with Disabilities
Hurdles to access healthcare
Like other basic demands, getting access to healthcare is an ongoing battle for most of the people living with disabilities. Too often, they are unable to access healthcare services and face major hurdles from family, community and health service provider level. This is not about just the physical access to buildings, but also access to services, information, care and support. According to WHO, an estimated 10 percent of the world's population — approximately 650 million people, of which 200 million are children — experience some form of disability. Although there is no national survey on the number of people with disabilities in Bangladesh, an estimated 10 percent means more than 15 million people are living with various types of disabilities. Basic healthcare for many of them remains a dream and everyone's right to access healthcare is largely ignored. A survey in rural Bangladesh done in decades ago on healthcare utilisation by disabled persons revealed that social and cultural barriers prevent certain groups, notably women and demographically dependent age groups, from accessing healthcare. Those who are economically viable, usually utilise healthcare services. Disabled persons whose families perceived they were disabled were 14 times more likely than that of others to seek treatment. At family level, there is lack of awareness and false beliefs. Family members often think that disabilities are the fate and there are very little options for treatment. They usually hide this people and do not allow to interact at community level where they might come in contact with conscious people who can help improve the quality of their lives. In many cases, family members are ignorant of simple and inexpensive tools that can remove or mitigate their disabilities and enhance the quality of living. For instant, a simple spectacle or a hearing aid can mitigate the person's disability of refractive error and mild to moderate deafness. Again, there are medical and surgical interventions like drugs for epilepsy, cataract surgery to remove blindness, cochlear implant for severe deafness can completely remove their disabilities. "The current activities of NGOs working for people with disabilities only cover about 20-25 percent area of Bangladesh. The remaining huge portion is still under-reported. Most of these people think healthcare as the kindness to them rather their right. There is urgent need of creating awareness regarding the rights of people to access healthcare properly", said Khandokar Jahurul, Executive Director, National Forum of Organizations Working with Disability, (NFOWD). Barriers also exist at the health service provider level. Doctors and other healthcare professionals are not properly oriented to deal with people with disabilities. Although these people need special attention, many healthcare professionals are even reluctant to see them. "Physicians are only focused on the particular physical problems that cause disabilities. The primary healthcare, support to mental health and counselling are largely overlooked beyond the attention to their disability. Many of them do not have very good attitudes", expressed Fahmida Khatun, a woman who is blind and working as visual trainer cum braille expert in Rainbow Bridge Foundation. Health infrastructure, lack of skilled manpower, allocation of budget are also considered as important factors that need proper and timely attention. Ministry of Social Welfare is particularly concerned for these people and allocates the budget for people with disability. Others ministries are turning a blind eye and reluctant to allocate budget for them. As a result, access to healthcare facilities like other rights is hampered due to the obstacles from all corners of the society. Lack of healthcare professional trained to work for disability is a strong barrier for access to healthcare. For example, it is hard to find a physiotherapist or people trained to deal with disability in rural areas that is extremely needed for many of these people. "That is why we need the Community Based Rehabilitation (CBR), where community people will be trained and people with disabilities will have access to rehabilitation in their own communities using predominantly local resources," said Dr Muhit, International eye health and disability expert and chairman of Child Sight Network. "A long-term programme which includes disability training for healthcare workers and existing local government infrastructure for intensive Community Based Rehabilitation (CBR) will improve quality of life for disabled persons and needs urgent implementation," he added. A significant proportion of people with disabilities are experiencing difficulty accessing adequate and appropriate primary healthcare services. Proper attention to them is an urgent need to promote and protect the health of people with disabilities. E-mail: rajibssmc@gmail.com
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