The objectives of this study were to investigate the pattern of healthcare services access among persons with disabilities in Bangladesh and its associated socio-demographic factors. We found that approximately 75% of persons with disabilities accessed healthcare services when needed within three months of the survey, while the remaining respondents did not. More than one-fourth of those who accessed healthcare services did so from governmental healthcare facilities. Additionally, over half of those who did not access healthcare services cited the cost of healthcare as a barrier. We observed a higher likelihood of healthcare services access among persons with disabilities belonging to higher wealth quintiles and residing in the Chattogram and Sylhet divisions. Unmarried or divorced/widowed/separated persons with disabilities reported lower likelihoods of accessing healthcare services. These findings are robust as they are derived from a large-scale nationally representative survey and adjusted for a broad range of confounding factors. The results underscore the need for targeted interventions to ensure access to healthcare services for persons with disabilities in Bangladesh.
The findings of this study indicate that one in every four persons with disabilities in Bangladesh could not access healthcare services when needed. Although we could not validate these findings due to the lack of relevant literature at the national level, previous small-scale studies suggest that this is the ongoing reality in Bangladesh as well as other LMICs14,17,26,28. A 2024 study published using the same survey data that analysed in this study indicates that persons with disabilities in Bangladesh mostly suffer from non-communicable diseases and several chronic conditions, including diabetes and hypertension, which typically require long-term care with continuity5. Inability to access such care can lead to the development of severe health issues, including kidney failure5. This, coupled with our study findings, highlights the severe vulnerability that persons with disabilities in Bangladesh are currently facing.
Several factors contribute to the challenges faced by persons with disabilities in accessing healthcare services. One significant challenge is the financial difficulties encountered by persons with disabilities in Bangladesh, consistent with our study findings and those of other available studies in Bangladesh and other LMICs7,29,30,31. Persons with disabilities in Bangladesh are often marginalized when it comes to engaging in economic activities7. The transportation and education systems in Bangladesh are typically not disability-friendly, with limited accessibility for wheelchairs and other disability support aids6,14,17. Additionally, persons with disabilities face significant barriers at the community level regarding their participation in education7. The job market in Bangladesh is highly competitive, making it difficult for persons with disabilities to sustain employment until they secure a job, especially with comparatively lower education levels, and receive adequate support afterward32. Consequently, these issues restrict the work participation of persons with disabilities, leading them to depend on their families and the government’s social safety net programs to meet their basic needs throughout their lives32,33. This long-term dependency is often unwelcomed at the family level. Moreover, the social safety net programs developed by the government are inadequate in terms of coverage and support provided, with persons with disabilities receiving only a nominal monthly stipend of nearly 8 USD from the government7. This lack of financial resources hinders their ability to access basic services when needed, including healthcare services, as reported in this study.
Infrastructural challenges at the healthcare facility level exacerbate these difficulties. This includes healthcare facilities that are not disability-friendly in terms of access and service provision14,17. Government healthcare facilities, which were reported as major sources of accessing healthcare services by persons with disabilities in this study as well as in other studies in Bangladesh, are often overcrowded, leading to long wait times for services14. Moreover, under the current healthcare structure in Bangladesh, respondents need to visit sub-district and district levels to access healthcare services, with a lack of services at the community level34,35. These factors contribute to persons with disabilities being highly dependent on family members to access healthcare services7. The inability to do so results in lower access to healthcare services, as reported in this study and other studies conducted in Bangladesh, as well as other LMICs14,28,35.
This research reveals a declining likelihood of accessing essential healthcare services with increasing age among individuals with disabilities. This trend aligns with recent studies in South Asia, including Bangladesh, and Africa, highlighting similar disparities faced by younger children with disabilities36,37. This concerning link between age and healthcare access might stem from several interconnected factors. Firstly, strong family bonds and a deeper sense of responsibility often lead parents to prioritize the healthcare needs of their younger children36. This attentiveness might wane with age, as expectations shift towards greater independence. Secondly, younger individuals with disabilities often rely heavily on their parents for daily care and healthcare decision-making. As they age and gain more autonomy, navigating the complexities of the healthcare system independently can become a significant barrier5. Finally, adults with disabilities often receive support from a wider network, including extended family, government programs, and community services. While beneficial, navigating this complex web of support can be challenging, contributing to access disparities. In response, it is crucial to implement awareness campaigns highlighting the importance of healthcare access for individuals with disabilities across all age groups, develop age-specific support systems catering to the unique needs of children and adults with disabilities, and empower individuals with disabilities to advocate for their own healthcare needs and navigate the system effectively. However, these focal points are lacking in LMICs and specifically in Bangladesh.
We identified a decreased likelihood of accessing healthcare services among persons with disabilities who are not in formal partnerships. This finding prompt consideration of several potential underlying factors. Firstly, individuals without formal partners may lack the social support typically provided by a partner, which can be instrumental in navigating healthcare systems, scheduling appointments, or arranging transportation to healthcare facilities38. Secondly, persons with disabilities who are not in formal partnerships may face heightened financial burdens, including higher out-of-pocket healthcare costs, which could deter them from seeking necessary medical care39. Furthermore, emotional barriers may play a role. Those without formal partners may experience feelings of loneliness or isolation, which can impact their motivation or ability to engage with healthcare services39,40. Lastly, stigma and discrimination within healthcare settings may contribute to lower healthcare access. Individuals without formal partners may encounter bias or prejudice, leading to reluctance or avoidance in seeking care41.
We found divisional-level variations in healthcare services access among persons with disabilities in Bangladesh, with respondents in Sylhet and Chattogram divisions reporting higher likelihoods of accessing healthcare services. These findings are consistent with previous studies in Bangladesh, which have also documented variations in healthcare services access across divisions34,35. Several factors may contribute to these divisional-level variations. Geographic disparities, such as differences in healthcare infrastructure and availability of facilities, could play a significant role. Sylhet and Chattogram divisions may have better-developed healthcare systems, resulting in improved access for persons with disabilities6. Socioeconomic differences between divisions, including variations in income levels and employment opportunities, could also impact healthcare access6,7. Additionally, population distribution and cultural factors may influence healthcare services access, with divisions having larger populations or different cultural attitudes towards disability potentially affecting service availability and utilization.
We discovered that one in four persons with disabilities in Bangladesh do not access healthcare services when needed. The reasons for not accessing healthcare services include the associated costs, lack of family support, and the absence of healthcare centres in their area. Additionally, we found that the likelihood of accessing healthcare services varied depending on marital status, family wealth quintile, and place of residence. These findings highlight the severe vulnerability faced by persons with disabilities in Bangladesh. Policies and programs aimed at ensuring healthcare services for persons with disabilities are crucial. This includes raising awareness about the importance of ensuring healthcare services for persons with disabilities and strengthening healthcare facilities to provide appropriate care. The government should also consider incorporating free healthcare services for persons with disabilities as part of its social safety net program.
This study possesses several strengths as well as a few limitations. To our knowledge, it represents the first nationally representative exploration conducted in Bangladesh examining the access to healthcare services among persons with disabilities at the national level and its correlates. It is based on a sizable sample derived from a nationally representative household survey, and recognized procedures were utilized to measure the receipt of healthcare services. Comprehensive statistical modelling employing a hierarchical data structure was employed for data analysis, with sampling weights considered in all analyses. Consequently, the findings are robust and applicable for informing the development of national-level policies and programs. However, the primary limitations of this study include the reliance on cross-sectional data, which limits our ability to establish causality, as the findings are purely correlational. Additionally, the survey relied on self-reported healthcare data, which may introduce the potential for misreporting certain healthcare experiences. Data were collected through respondent-provided answers without validation opportunities, suggesting the possibility of recall bias, although any such bias is likely to be random. Moreover, aside from the factors adjusted in the model, health and environmental variables may contribute to healthcare utilization, underscoring their importance for inclusion in the model. Unfortunately, these data were unavailable in the survey, limiting our ability to consider them. Despite these limitations, the findings of this study are poised to make meaningful contributions to the development of national-level policies and programs.
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