Analysis of the impact of healthcare support initiatives for physically disabled people on their access to care in the city of Saint-Louis, Senegal

People with disabilities represent approximately 6% of the Senegalese population. They face significant barriers to accessing health care. Although several initiatives have been implemented to improve access to health care for this vulnerable population, few studies have examined the effects of these initiatives. We conducted a mixed methods study in three neighborhoods in Saint-Louis City (Senegal) to assess the impact of health systems and social assistance programs aimed at improving access to health care for people with disabilities. Data were collected from 105 people living with disabilities aged 1-49 years (or their caregivers). Interviews were also conducted with key stakeholders in the health and welfare sectors. Global Positioning System (GPS) coordinates of all the health and social services within the city were obtained. We also conducted observations in the main regional hospital, the district health center and three level-one health facilities to assess physical accessibility as well as interactions between patients living with disabilities and health and social workers. Descriptive and multivariate analyses were performed using Sphinx software. Spatial data were used to make cartographic representations of the proximity to basic social services using Arc GIS software. Seventy-nine percent of survey respondents reported difficulty obtaining treatment. Key barriers to care included the high cost of care, as well as ill-treatment by health workers. Limited human resources and low levels of financial support, combined with logistical challenges were reported to hamper the success of social welfare initiatives that aim to facilitate access to health care for people with disabilities. Our results suggest that initiatives to increase access to health care among people with disability in Saint-Louis have had limited impact. Study findings underscore the importance of strengthening social assistance schemes within the health system and the need for social workers and health workers to collaborate to improve access to health care for people with disabilities.