Beyond Disability: Inclusive Healthcare Delivery in Nigeria.

Salt House prides in accelerating inclusive practices and social justice in key public sectors. Amongst our key priorities is Inclusive Healthcare Delivery in Nigeria, which palpably is a multifaceted issue influenced by various factors. Inclusive healthcare delivery is a vital concept that extends well beyond addressing physical disabilities alone. While disabilities undoubtedly require specific healthcare adaptations, an inclusive healthcare system should account for a wider spectrum of patient needs that intersect with various social, economic, and cultural barriers.

In recent years, the global health community, including frameworks by the United Nations, has increasingly promoted inclusive healthcare, emphasizing universal accessibility. However, these efforts often fall short of addressing the many overlapping barriers individuals encounter, and the unique experiences of each oerson. By exploring how inclusive healthcare can impact everyone—regardless of ability, economic background, ethnicity, gender, or age—we gain a fuller picture of why transforming healthcare into a truly inclusive system is essential for all.

Disclaimer: Our approach to inclusive development stems from the perspective of the term “disability”, and how it manifests across a wide spectrum—temporary, situational and longterm. According to the United Nations Convention of the Rights of Persons With Disabilities, disability is defined as “those who have long-term physical, mental, intellectual or sensory impairments which in interaction with various barriers may hinder their full and effective participation in society on an equal basis with others”. In the course of this publication, we refer to the Salt House definition of disability.

Disability occurs when there is a mismatch between the needs of an individual and the environment provided. Such occurrences may be situational, temporary or longterm, as well as influenced by social, economic or environmental factors.

This Write For Change publication explores the broad implications of inclusive healthcare, especially how it benefits not only Nigerians with disabilities but also other vulnerable populations who face barriers due to language, socioeconomic status, geography, and cultural differences. We will also critically assess the United Nations and other global health initiatives’ current frameworks and why they sometimes fail to address these intersecting challenges, resulting in a need for more comprehensive approaches.

Understanding Inclusive Healthcare Delivery

Healthcare accessibility is a critical component of any nation's development. In Nigeria, a country with over 200 million people and a rich tapestry of ethnic, religious, and cultural diversity, ensuring equitable healthcare access is particularly challenging. Inclusive healthcare refers to the principle of delivering healthcare services that accommodate the needs of all individuals, regardless of physical, cognitive, cultural, or economic differences. It means creating a healthcare environment that minimizes barriers and promotes equality by providing care in a way that is accessible, affordable, and sensitive to the needs of diverse populations. This concept encompasses disability-inclusive practices, but it also extends to ensuring that all vulnerable groups can access healthcare services equitably.

Inclusive healthcare systems addresses various social determinants of health that create barriers for those who may not necessarily identify as disabled. These factors, such as poverty, location, language, and even discrimination based on gender or ethnicity, contribute to healthcare inequalities.

Ethnic Issues in Healthcare Accessibility

Nigeria is home to over 250 ethnic groups, each with its own language, culture, and traditions. This diversity, while enriching, also poses significant challenges to healthcare delivery. Ethnic disparities in healthcare access are evident in several ways. In addition, ethnic groups in rural areas often have less access to healthcare facilities compared to those in urban centres. For instance, the northern regions, predominantly inhabited by the Hausa-Fulani, have fewer healthcare facilities and lower health indices compared to the southern regions.

With over 500 languages spoken in Nigeria, language can be a significant barrier to effective healthcare delivery. Patients who do not speak the dominant languages (Hausa, Yoruba, Igbo) may have difficulty communicating with healthcare providers, leading to misunderstandings and inadequate care.

Case Study: Research conducted among pregnant women and nursing mothers in seven Primary Health Centres in Obot Akara, Akwa Ibom State, identified language as a significant barrier to effective healthcare delivery. The study found that understanding the language of healthcare providers was crucial for patient compliance and satisfaction. This underscores the importance of providing translation services and health information in multiple languages.

Cultural and Religious Insensitivity

Cultural and religious beliefs play a significant role in how patients interact with healthcare systems in Nigeria. Many healthcare facilities fail to respect these beliefs, resulting in mistrust and non-compliance with medical recommendations. Healthcare providers must be trained in cultural competence, including understanding religious practices and ensuring privacy and respect for patients’ beliefs. Simple measures, such as offering female staff for female patients when requested, can build trust and encourage more people to seek care.

Case Study: In an Abuja clinic, Halima, a Muslim woman, was asked to remove her hijab during a medical examination in a room without proper privacy. Feeling uncomfortable and disrespected, she refused the examination and left without receiving the care she needed. Instances like this highlight the need for culturally sensitive practices within healthcare facilities.

Physical Barriers in Healthcare Facilities

Physical accessibility is one of the most visible barriers within healthcare facilities in Nigeria. Many hospitals and clinics lack basic infrastructure such as ramps, elevators, or wide hallways, making it difficult for people with mobility challenges to navigate the premises.

Case Study: Emeka, a 40-year-old man who uses a wheelchair, visited a government hospital in Lagos for a checkup. Upon arrival, he discovered there were no ramps leading to the building, and the consultation rooms were located on the second floor with no elevators or stairlifts available. Emeka had to rely on strangers to carry him up the stairs, an experience that left him feeling embarrassed and frustrated.

For patients like Emeka, these structural deficiencies discourage regular hospital visits, leading to delayed or forgone care. Addressing these barriers requires stricter enforcement of Nigeria’s Discrimination Against Persons with Disabilities (Prohibition) Act, which mandates accessibility in public buildings, including hospitals.

Lack of Training and Specialised Services

Healthcare workers in Nigeria often lack the training and tools to provide inclusive care, particularly for patients with disabilities or chronic illnesses. Specialized services, such as mental health care or pediatric care for children with special needs, are also limited in most facilities. To improve inclusivity, healthcare facilities must provide ongoing training for staff and establish specialized units to address diverse patient needs effectively.

Case Study: Chidi, a young man experiencing severe anxiety, visited a clinic in Enugu seeking help. The healthcare workers dismissed his symptoms as “stress” and offered no further support or referral to a mental health specialist. Without proper care, Chidi’s condition deteriorated, impacting his ability to work and maintain relationships.

Overcrowding and Poor Facility Management

The lack of adequate appointment/queue management systems and prioritisation policies to address overcrowding in healthcare facilities create significant barriers to care, particularly in public hospitals where resources are limited. Long waiting times, inadequate staffing, and insufficient medical supplies often leave patients underserved. Improving facility management, increasing healthcare funding, and adopting digital systems for patient scheduling can help address overcrowding and ensure timely care for all patients.

Case Study: At a PHC hospital in Ibadan, patients frequently wait for hours or even days to see a doctor due to overcrowding. Mrs Ajayi, a 58-year-old diabetic patient, arrived early in the morning for her scheduled appointment but was unable to see a doctor until late in the evening. The delay caused her condition to worsen, and she required emergency intervention.

Addressing the Challenges

To improve healthcare accessibility in Nigeria, a multifaceted approach is needed. Here are some recommendations:

1. Improving Infrastructure: Investing in healthcare infrastructure, particularly in rural and underserved areas, is crucial. This includes building more healthcare facilities, improving transportation networks, and ensuring that facilities are accessible to people with disabilities.

2. Cultural Competence Training: Healthcare providers should receive training in cultural competence to better understand and respect the diverse cultural and religious beliefs of their patients. This can improve patient-provider communication and increase trust in the healthcare system.

3. Community Engagement: Engaging with community leaders and religious organizations can help to address cultural and religious barriers to healthcare. Community-based health education programs can raise awareness about the importance of seeking timely medical care and dispel myths and misconceptions about certain medical treatments.

4. Policy and Legislation: The government should enact and enforce policies that protect the rights of people with disabilities and ensure their access to healthcare. This includes implementing the Discrimination against Persons with Disabilities (Prohibition) Act and ensuring that all new healthcare facilities are built to be accessible.

5. Inclusive Health Programs: Health programs should be designed to be inclusive of all populations, including ethnic minorities, religious groups, and people with disabilities. This includes providing services in multiple languages, offering culturally appropriate care, and ensuring that disability services are integrated into mainstream healthcare.

Conclusion

Healthcare accessibility in Nigeria is a complex issue influenced by ethnic, religious, and disability factors. Addressing these challenges requires a comprehensive approach that includes improving infrastructure, training healthcare providers, engaging with communities, enacting supportive policies, and designing inclusive health programs. By taking these steps, Nigeria can move closer to achieving equitable healthcare access for all its citizens.

References

(1) Addressing stigma to achieve healthcare equity and universal health .... https://link.springer.com/article/10.1007/s44282-024-00104-1.

(2) Religion, culture, and discrimination against persons with disabilities .... https://ajod.org/index.php/ajod/article/view/192.

(3) SOCIAL–CULTURAL CONSTRAINTS TO HEALTH CARE ACCESS IN NIGERIA: A STUDY .... https://internationalpolicybrief.org/wp-content/uploads/2023/12/Comparative-studies10.pdf.

(4) Accessibility to infrastructure and disability rights in Nigeria: an .... https://www.academia.edu/89998401/Accessibility_to_infrastructure_and_disability_rights_in_Nigeria_an_analysis_of_the_potential_of_the_discrimination_against_persons_with_disability_prohibition_act_2018.

(5) Social inclusion of persons with disabilities in Nigeria: Challenges .... https://blogs.worldbank.org/en/nasikiliza/social-inclusion-persons-disabilities-nigeria-challenges-and-opportunities.

(6) Religion, culture, and discrimination against persons with disabilities in Nigeria https://doi.org/10.4102/ajod.v5i1.192.