CHAPTER ONE INTRODUCTION

    Background of the Study

Access to quality and timely healthcare is essential to the health and well-being of all individuals with no exception to persons with disabilities (Beatty, Hagglund, Neri, Dhont, Clark & Hilton, 2003). However, people in developing countries tend to have less access to healthcare than those in developed countries (Peters, Garg, Bloom, Walker, Brieger & Rahman, 2008). But even within these developing countries, the poor have limited access to healthcare due to inadequate financial resources and information (Peters et al., 2008). Furthermore, access to healthcare in Africa manifests it in several aspects including geographical location, accessibility, affordability, availability, and acceptability (O’Donnell, 2007).

Geographical location refers to the setting of health facilities that provide healthcare to people (Bart, Ir, Bigdeli, Annear & Damme, 2011). The closer the geographical setting of health facilities to people, the easier the accessibility of healthcare. According to Bart et al. (2011), accessibility refers to how resources are easily reached at health facilities and these include accessible doors, entrances, ramps, and elevators. Also, lack of available and affordable transportation options and healthcare system barriers, such as ineffective health insurance scheme mostly obstruct individuals’ access to and utilization of healthcare (Marcela Fraizer & Kleinstein, 2009). Affordability of healthcare refers to the cost of healthcare, readiness and capability of the service user to pay for services rendered while available resources, such as a number of health facilities and health professionals, adequate drugs and equipment at health facilities reflect the availability of healthcare (Bart et al., 2011).

In some African countries, quality healthcare delivery is negatively impacted due to lower government budget to finance healthcare, as well as inadequate health insurance coverage (Economist Intelligent Unit, 2017). Furthermore, financial constraints have resulted in the inability of patients to pay for the cost of healthcare provided at health facilities (Atuguba, 2013). Moreover, inadequate health professionals and poor interpersonal skills of health professionals affect access to healthcare (Jacobs, Ir, Bigdeli, Annear, & Damme, 2011). Acceptability of healthcare is the expectation of health service users and the attitudes of healthcare professionals at health facilities (Bart et al., 2011).

Every individual in the world is entitled to quality healthcare (Inclusion Ghana, 2013) irrespective of his or her age, status, educational background, race, disability, gender among other factors (World Health Organization, 2011; Moodley & Ross, 2015). The right to quality healthcare has been enshrined in international and regional human rights treaties such as the African Charter on Human and Peoples’ Rights (ACHPR), as well as other national legislations (Schierenbeck, Johansson, Andersson & Van, 2013) including the 1992 Constitution of the Republic of Ghana which notes that every individual is supposed to enjoy the right to quality healthcare (Inclusion Ghana, 2013). Similarly, the Patient’s Charter of the Ghana Health Service ensures the right of the individual to accessible, fair and comprehensive healthcare without difficulties (Ghana Health Service, n.d.).

In addition, there are international and national laws which protect the right to healthcare for persons with disabilities. These laws include the Convention on the Rights of Persons with Disability (CRPD) and the Persons with Disability Act (715) of Ghana. For instance, Article 25 of the Convention on the Rights of Persons with Disability states that state parties must recognize that persons with disabilities have the right to the enjoyment of the highest attainable

standard of healthcare without discrimination on the basis of their conditions. This is important because, persons with disabilities as compared to those without disabilities have distinctive health needs which result in increased demand for healthcare due to their complex health conditions (Reichard, Stolzle, & Fox, 2011).

Persons with disabilities represent one of the most vulnerable groups (Hwang, Johnston, Tulsky, Dyson-hudson, Wood & Eugene, 2009) and largest minority group in the world (Bella & Dartanto, 2016). Globally, it is estimated that about 650 million people live with some form of disability (United Nations enable, 2017). Also, about 20 percent of the world’s poorest population have a disability and are considered as the most disadvantaged (United Nations enable, 2017). In Ghana, more than 5 million people out of the total population live with some form of disability (Human Rights Watch, 2012). Furthermore, out of the total number of persons with disabilities in Ghana, 25.4 percent have a physical disability (Ghana Statistical Service, 2013).

Disability refers to the limitation of a person’s ability to function or carry out daily activities due to physical, intellectual, sensory or mental impairment (South African Revenue Service, 2012). Disability takes various forms which include sensory, physical, intellectual and cognitive (Government of Western Australia Department of Health, 2014). Physical disability is the most common form of disability and it usually relates to musculoskeletal, circulatory, respiratory and nervous disorders (Government of Western Australia Department of Health, 2014). Physical disability is a common issue in Africa and it continues to increase because of natural disasters, diseases and accidents (Baffoe & Dako-Gyeke, 2013).

Persons with disabilities are one of the marginalized groups in society who encounter challenges in all spheres of life including accessing healthcare (Imoro, 2015). They have difficulties

accessing healthcare due to low income, unemployment and stigmatization (Imoro, 2015) as well as environmental barriers such as inaccessible transport system and infrastructure (Naami, 2014; Tijm, Cornielje, & Edusei, 2011). In Ghana, persons with disabilities encounter barriers in accessing healthcare regardless of both international and local legislations such as the United Nations Convention on the Right of Persons with Disability and the Persons with Disability Act, 2006 (Act 715) of Ghana. The healthcare system in Ghana has failed to address some of the needs of persons with disabilities due to the limited implementation of health policies that specifically address their health issues (Slikker, 2009). Additionally, persons with disabilities in Ghana are underrepresented in the health sector development programs such as the National Health Insurance Scheme (NHIS) (Badu, Agyei- Baffour & Peprah Opoku, 2016). For this reason, the NHIS which covers most ordinary diseases excludes rehabilitation services and assistive devices, as well as covering unique health issues that relate to their disability thereby making its benefit limited for persons with disabilities (Ghana Federation of the Disabled, 2008).

Furthermore, even though the National Health Insurance Scheme (NHIS) was established in 2003 to provide inexpensive and quality basic healthcare, as well as address the inequality in the healthcare system for all residents in Ghana with no exception to persons with disabilities, outcome for persons with disabilities is inadequate (National Health Insurance Authority, 2013; National Health Insurance Act, 2012). This has contributed to the numerous challenges that persons with disabilities encounter in accessing healthcare at health facilities (Inclusion Ghana, 2013; Danso, Ayarkwa & Dansoh, 2011). Moreover, many persons with disabilities have not been able to register onto the NHIS to access healthcare because of financial difficulties and other challenges such as discrimination that they encounter due to their conditions (Mensah, Williams, Atta-Ankomah, & Mjomba, 2008). For this reason, the need to identify and eliminate

the barriers persons with disabilities encounter in accessing healthcare is fundamental in the quest to ensure inclusion and social justice.