Inclusion of people with disabilities in Chilean health policy: a policy analysis

BackgroundAround 18% of the population in Chile has disabilities. Evidence shows that this population has greater healthcare needs, yet they face barriers to accessing healthcare due to health system failures. This paper aims to assess the inclusion of people with disabilities in health policy documents and to explore the perceptions of key national stakeholders regarding the policy context, policy processes, and actors involved.MethodsA policy content analysis was conducted of 12 health policy documents using the EquiFrame framework, adapted to assess disability inclusion. Documents were reviewed and rated on their quality of commitment against 21 core concepts of human rights in the framework. Key national stakeholders (n = 15) were interviewed, and data were thematically analysed under the Walt and Gilson Policy Analysis Triangle, using NVivo R1.ResultsCore human rights concepts of disability were mentioned at least once in nearly all health policy documents (92%). However, 50% had poor policy commitments for disability. Across policies, Prevention of health conditions was the main human rights concept reflected, while Privacy of information was the least referenced concept. Participants described a fragmented disability movement and health policy, related to a dominant biomedical model of disability. It appeared that disability was not prioritized in the health policy agenda, due to ineffective mainstreaming of disability by the Government and the limited influence and engagement of civil society in policy processes. Moreover, the limited existing policy framework on disability inclusion is not being implemented effectively. This implementation gap was attributed to lack of financing, leadership, and human resources, coupled with low monitoring of disability inclusion.ConclusionsImprovements are needed in both the development and implementation of disability-inclusive health policies in Chile, to support the achievement of the right to healthcare for people with disabilities and ensuring that the health system truly "leaves no one behind". Introducci & oacute;nAlrededor del 18% de la poblaci & oacute;n de Chile tiene discapacidad. Los datos demuestran que esta poblaci & oacute;n tiene mayores necesidades de salud, pero se enfrenta a barreras para acceder a la salud debido a las deficiencias del sistema sanitario. El objetivo de este estudio es evaluar la inclusi & oacute;n de las personas con discapacidad en las pol & iacute;ticas sanitarias y explorar las percepciones de actores nacionales en relaci & oacute;n al contexto pol & iacute;tico, los procesos pol & iacute;ticos y los actores implicados.M & eacute;todosSe realiz & oacute; un an & aacute;lisis de contenido de 12 pol & iacute;ticas sanitarias utilizando el marco EquiFrame, adaptado para discapacidad. Se calific & oacute; la calidad de compromiso de las pol & iacute;ticas con respecto a 21 conceptos de derechos humanos del EquiFrame. Se entrevist & oacute; a 15 actores nacionales, y los datos se analizaron tem & aacute;ticamente seg & uacute;n el Tri & aacute;ngulo de Pol & iacute;ticas de Walt y Gilson, utilizando NVivo R1.ResultadosLos conceptos de derechos humanos en materia de discapacidad se mencionaron al menos una vez en casi todas las pol & iacute;ticas sanitarias (92%). Sin embargo, en el 50% de los casos los compromisos pol & iacute;ticos en materia de discapacidad eran escasos. En todas las pol & iacute;ticas, la Prevenci & oacute;n de los problemas de salud fue el principal concepto de derechos humanos reflejado, mientras que la Privacidad de la informaci & oacute;n fue el concepto menos mencionado. Los participantes describieron un movimiento de la discapacidad y una pol & iacute;tica sanitaria fragmentados, relacionados con un modelo biom & eacute;dico dominante de la discapacidad. Pareciera que la discapacidad no es prioritaria en la agenda pol & iacute;tica sanitaria, debido a su ineficaz integraci & oacute;n por parte del Gobierno y a la limitada participaci & oacute;n de la sociedad civil en los procesos pol & iacute;ticos. Adem & aacute;s, el limitado marco pol & iacute;tico existente sobre salud inclusiva no se est & aacute; implementando eficazmente. Esta deficiencia en la implementaci & oacute;n se atribuy & oacute; a la falta de financiamiento, liderazgo y recursos humanos, junto con el escaso monitoreo de la discapacidad.ConclusionesSe requieren mejoras tanto en el desarrollo como en la implementaci & oacute;n de pol & iacute;ticas de salud inclusivas de la discapacidad en Chile, para apoyar el alcance del derecho a la salud de las personas con discapacidad y asegurar que el sistema de salud realmente "no deje a nadie atr & aacute;s".