Perceptions and experiences of access to public healthcare by people with disabilities and older people in Uganda

International Journal for Equity in Health

Rachel Hammonds²  Katie Brooker³  Ana Lorena Ruano⁵  Claire E Brolan⁴  Juliana Nantaba¹  Moses Mulumba¹ 

[1] Center for Health, Human Rights and Development, Kampala, Uganda;Institute of Tropical Medicine, Antwerp, Belgium;Queensland Centre for Intellectual and Developmental Disability, The University of Queensland, Brisbane, Australia;School of Population Health, The University of Queensland, Brisbane, Australia;Department of Global Public Health and Primary Care, Center for International Health, University of Bergen, Centro de Estudios para la Equidad y Gobernanza en los Sistemas de Salud, Bergen, Guatemala, Guatemala

关键词: Human rights;    Go4Health;    Sustainable development goals;    Millennium development goals;    Older persons;    Persons living with disabilities;    Uganda;    Africa;   

Others  :  1137646
DOI  :  10.1186/s12939-014-0076-4

 received in 2014-06-19, accepted in 2014-08-20,  发布年份 2014

【 摘 要 】

Introduction

In the year 2000, a set of eight Millennium Development Goals (MDGs) were presented as a way to channel global efforts into the reduction of poverty and the promotion of social development. A global discussion regarding how to renew these goals is underway and it is in this context that the Goals and Governance for Global Health (Go4Health) research consortium conducted consultations with marginalized communities in Asia, Latin America, the Pacific and Africa as a way to include their voices in world’s new development agenda. The goal of this paper is to present the findings of the consultations carried out in Uganda with two groups within low-resource settings: older people and people living with disabilities.

Methods

This qualitative study used focus group discussions and key informant interviews with older people in Uganda’s Kamwenge district, and with persons with disabilities from the Gulu region. Thematic analysis was performed and emerging categories and themes identified and presented in the findings.

Findings

Our findings show that a sense of community marginalization is present within both older persons and persons living with disabilities. These groups report experiencing political sidelining, discrimination and inequitable access to health services. This is seen as the key reason for their poor health. Clinical services were found to be of low quality with little or no access to facilities, trained personnel, and drugs and there are no rehabilitative or mental health services available.

Conclusion

Uganda must fulfil its international obligations and take progressive measures to meet the right to health for all its peoples, but especially allocate its limited resources to proactively support its most marginalized citizens. The growing impetus within post-2015 development negotiations to redress in-country health and other inequalities through a comprehensive systems approach is of importance in the Ugandan development context. This approach reflects the participant’s perspectives, which also calls for a more equitable approach to health and development as opposed to a narrow, vertical focus on specific population groups, as was the case with the MDGs.

【 授权许可】

   
2014 Mulumba et al.; licensee BioMed Central Ltd.

【 参考文献 】

• [1]International convention of the rights of persons living with disabilities. United Nations, New York; 2006.
• [2]Sen A: The idea of justice. Harvard University Press, Boston; 2009.
• [3]Global age watch index. 2013.
• [4]Moore A: Older people living with HIV/AIDS (OPLWA) i Lome, Togo: personal networks and disclosure of serostatus. Ageing Int 2013, 38(3):218-232.
• [5]Shevington S: Is quality of life poorer for older adults with HIV/AIDS? International evidence using the WHOQoL-HIV. AIDS Care Psychological and socio-medical aspects of HIV/AIDS 2012, 24(1):1219-1225.
• [6]Holmes W, Joseph J: Social participation and healthy ageing: a neglected, significant protective factor for chronic, non-communicable conditions. Global Health 2011, 7:43. BioMed Central Full Text
• [7]Bank W: Uganda: social inclusion with middle-income status in sight. World Bank, Washington DC; 2014.
• [8]Uganda demographic and health survey 2011. Uganda Bureau of Statistics, Kampala; 2012.
• [9]26 December 1966, 993 U.N.T.S. 3, 6, I.L.M. 360 (1967) (entered into force 3 January 1976). 1966.
• [10]A life of dignity for all: accelerating progress towards the Millennium Development Goals and advancing the United Nations development agenda beyond 2015. United Nations, New York; 2013.
• [11]The millennium development goals report. United Nations, New York; 2013.
• [12]A new global partnership: eradicate poverty and transform economis through sustainable development. United Nations, New York; 2013.
• [13]Kenny C, Glassman A: What will follow the millennium development goals? the high level panel's ambitious recommendations on health deserve support. BMJ 2013, 347:f4431.
• [14]Friedman A, Jahn A, Ooms G, Sridhar D, Waris A: Realizing the right to health for everyone: the health goal for humanity. Go4Health research consortium, Copenhagen; 2013.
• [15]Flores W, Ruano AL, Phé-Funchal D: Social participation within a context of political violence: implications for the promotion and exercise of the right to health in Guatemala. Health Human Rights 2009, 11(1):37-48.
• [16]Wegner P: Genocide in northern Uganda? -The protected camps’ policy of 1999–2006. [http:/ / justiceinconflict.org/ 2012/ 04/ 09/ a-genocide-in-northern-uganda-the-p rotected-camps-policy-of-1999-to-20 06/ ] webciteJustice in Conflict [Internet] 2012. March 20, 2014. Available from: http://justiceinconflict.org/2012/04/09/a-genocide-in-northern-uganda-the-protected-camps-policy-of-1999-to-2006/
• [17]Vindevogel S, de Schryver M, Broekaert E, Derluyun I: Challenges faced by former child soldiers in the aftermath of war in Uganda. J Adolesc Health 2013, 52(6):757-764.
• [18]Spitzer H, Twikirize J: War-affected children in northern Uganda: no easy path to normality. Int Soc Work 2013, 56(1):67-69.
• [19]Branch A: Gulu in war… and peace? the town as camp in northen Uganda. Urban Stud 2013, 50(15):3153-3167.
• [20]McElroy T, Muyinda H, Atim S, Spittal P, Backman C: War, displacement and productive occupations in northern Uganda. J Occupational Sci 2012, 19(3):198-212.
• [21]District state of environment report Uganda: Gulu District Local Government Environmental Department 2005.
• [22]A document of women’s experiences in armed conflict in Uganda-the cae of Gulu district 1986–1999. 2000.
• [23]Patel S, Muyinda H, Sewankambo N, Oyat G, Atim S, Spittal P: In the face of war: examining sexual vulnerabilities of Acholi adolescent girls living in displacement camps in conflict-affected northern Uganda. BMC Int Health Human Rights 2012, 12(1):38. BioMed Central Full Text
• [24]Leibling-Kalifani H, Ojiambo-Ochieng R, Marshall A, Were-Ogottu J, Musisi S, Kinyanda E: Violence against women in northen Uganda: the neglected health consequences of war. J Int Women’s Studies 2008, 9(3):174-192.
• [25]Loewenson R, Flores W, Shukla A, Kagis M, Baba A, Ryklief A, Mbwili-Muleya C, Kakade D: Raising the profile on participatory action research at the 2010 global symposium on health systems research. MEDICC Rev 2011, 13(3):35-38.
• [26]Robson C: Real world research. John Wiley and Sons, New York; 2002.
• [27]Fereday J, Muir-Cochrane E: Demonstrating rigor using thematic analysis: a hybrid approach of inductive and deductive coding and theme development. Int J Qualitative Methods 2006, 5(1):1-11.
• [28]Braun V, Clarke V: Using thematic analysis in psychology. Qual Res Psychol 2006, 3:77-101.
• [29]Moon B: A life of dignity for all: accelerating progress towards the millennium development goals and advancing the United Nations development agenda beyond 2015. United Nations, New York; 2013.
• [30]Csordas T: Body/meaning/healing. Palgrave MacMillan, New York; 2002.
• [31]Harris C: Gender-age ssytems and social change: a Haugaardian power analysis based on resaerch from northern Uganda. J Political Power 2012, 5(3):475-492.
• [32]Ruano AL, Hernández A, Dahlblom K, Hurtig AK, SanSebastián M: ‘It’s the sense of responsibility that keeps you going’: stories and experiences of participation from rural community health workers in Guatemala. Archives Public Health 2012, 70(1):18. BioMed Central Full Text
• [33]World report on disability. WHO, Malta; 2011.
• [34]Kritzinger J, Schneider M, Swartz L, Braathen SH: “I just answer ‘yes’ to everything they say”: Access to health care for deaf people in Worcester, South Africa and the politics of exclusion. Patient Educ Couns 2014, 94(3):379-383.
• [35]Goicolea I, Coe A, SanSebastián M: Mechanisms for Achieving adolescent services in Ecuador: a realist evaluation approach. Global Health Action 2012, 2012(5):ᅟ.
• [36]Flores W: Evaluación del derecho a la salud en Guatemala utilizando a la salud materno-infantil como trazador. CEDIM, Guatemala; 2008.
• [37]Report of the United Nations Special Rapporteur on the Right to the Highest Attainable Standarf of Physical and Mental Health. United Nations, New York; 2005.
• [38]Convention on the rights of persons with disabilities, 26 December 1966, 993 U.N.T.S. 3, 6, I.L.M. 360 (1967) (entered into force 3 January 1976). 2006.
• [39]Ooms G, Latif L, Brolan C, Hammonds R, Friedman E, Mulumba M, Forman L: Is universal health coverage the practical expression of the right to health care?BMC Int Health Hum Rights 2014, 14(3): doi:10.1186/1472-698X-14-3.