Accessibility of Public Healthcare Facilities for People with Disabilities in Eastern Ethiopia: A Mixed-Methods Study

Imagine a world where a doctor's visit is a simple matter of walking through a door, sitting in a chair, and speaking with a professional. For many, this is a routine part of life. But for people with disabilities, the journey to receive care is often blocked long before they reach the examination room. The barriers are not just physical; they are also built into the way buildings are designed, the equipment that is available, and the training that medical staff receive. In countries with fewer resources, these obstacles can be especially steep, turning a basic right to health into a distant privilege. This reality forms the backdrop for a recent investigation in eastern Ethiopia, where researchers set out to measure exactly how easy or difficult it is for people with disabilities to access public healthcare. The study focuses on the gap between the promise of inclusive care and the physical and social reality on the ground.

The researchers traveled to the Dire Dawa region, a mix of city and countryside, to examine eighteen public health facilities. They did not rely on surveys or opinions alone; instead, they acted as auditors, walking through every part of the buildings to see what was actually there. They used a detailed checklist to measure things like the width of doorways, the slope of ramps, the height of counters, and the clarity of signs. They measured the distance from the parking area to the clinic entrance and checked if the floors were smooth or uneven. They also spoke with eighty-six healthcare workers, asking them about their daily experiences, their confidence in treating patients with disabilities, and the specific tools they lacked. By combining these physical measurements with the voices of the staff, the team built a complete picture of the situation.

The findings revealed a landscape of significant exclusion. The overall accessibility of these health facilities was found to be quite low, with the researchers calculating a score of just under forty percent. This means that for every ten steps a person with a disability might need to take to get care, six of those steps were likely blocked by a barrier. The situation was slightly better in the city than in the rural areas, but even the urban facilities fell far short of what is needed. When the researchers looked at specific types of disabilities, the results were stark. Facilities were somewhat more accommodating for people who use wheelchairs or have trouble walking, but they were almost entirely inaccessible for those with hearing or vision impairments, and nearly impossible for those with cognitive disabilities.

The physical environment told a story of missed opportunities and dangerous oversights. While many facilities had ramps, they were often too steep to climb safely or lacked handrails entirely. In some places, a ramp was built next to a staircase, but it was so narrow that a wheelchair could not turn around on it. Inside the buildings, the problems continued. In one specific instance observed during the audit, a major route of travel at a health center was obstructed by an open gutter, and the path was further hindered by unbeveled floor changes and slippery tiles. The signs that guided patients were rarely designed for people with visual impairments; they lacked high-contrast colors or Braille, and no facility offered audio directions. Perhaps most critically, the restrooms were largely unusable for anyone who could not squat or stand without support. Doors were too narrow, floors were too small to maneuver, and grab bars were missing. In one instance, a restroom designated for people with disabilities was found to be locked, requiring a patient to ask an administrator for the key, turning a basic need into a humiliating negotiation.

The examination rooms themselves presented further hurdles. While some facilities had loaner wheelchairs, the rooms lacked the specialized equipment needed to treat patients with mobility issues. There were no adjustable examination tables that could be raised or lowered to meet a patient where they were. There were no scales that could weigh a person while they remained in their wheelchair. Because of this missing equipment, healthcare workers often had to skip physical examinations entirely or rely on patients to guess their own weight. The lack of tools meant that care was often incomplete, leaving doctors to make decisions based on incomplete information.

The human element of the study provided a deeper understanding of why these gaps existed. The healthcare workers interviewed were not hostile; in fact, most expressed a genuine desire to help and acknowledged that people with disabilities often received worse care than others. However, they felt unprepared. The primary barrier they identified was a lack of training. They did not know how to communicate effectively with patients who were deaf or blind, nor did they know how to safely transfer a patient from a wheelchair to a bed without causing injury. Without the right tools and the right knowledge, they often relied on family members to do the heavy lifting, which stripped the patient of their autonomy and dignity. When they did try to adapt, their methods were often makeshift, such as speaking louder for a hearing-impaired patient or verbally describing the room for someone who was blind.

The study concludes that while the laws in Ethiopia exist to protect the rights of people with disabilities, the reality in these health centers has not caught up. The buildings were not designed with inclusion in mind, and the staff have not been equipped with the skills to bridge the gap. The researchers suggest that fixing this does not require a complete overhaul of every building, but rather a commitment to enforcing existing standards and providing essential training. By making simple changes, such as installing handrails, ensuring doors are wide enough, and teaching staff how to communicate with all patients, the healthcare system could become a place where everyone, regardless of their ability, can receive the care they need. The path forward is clear: the infrastructure must be made accessible, and the people who work within it must be empowered to serve everyone with dignity.