Two healthcare professionals support a boy through physiotherapy. The boy is being supported as he lies on a large exercise ball.
Sikampa (6) receives physiotherapy at AIC Kaijado Chid Care Centre, Kenya

Improving access to healthcare services for children with developmental disabilities

How do we improve healthcare access for children with developmental disabilities?

Let’s think back to the different steps in the healthcare journey, from perceiving that there is a need through to receiving a successful healthcare treatment, as described by Levesque’s framework of healthcare access.

In their framework, Levesque et al. argue that healthcare access is achieved through the interaction of supply-side (i.e. healthcare provider) and demand-side (i.e. healthcare user) influencers.

Supply-side factors result from the attributes of the health system and healthcare services, including the availability and location of services, the costs of those services and the professional’s knowledge and values.

Demand-side determinants result from an individual’s or household’s ability to access the service, including their health literacy, personal beliefs, mobility and income.

An infographic of Levesque's framework of healthcare access, represented as an arrow. There are boxes with text along the arrow and both above and below the arrow. At the top of the graphic, a box reads Supply and at the bottom a box reads Demand. Along the arrow, from left to right, it reads: 1. Central box = Healthcare needs, Top box = Approachability - Transparency, Outreach, Information, Screening, Bottom box = Ability to perceive - Health literacy, Health beliefs; 2. Central box = Perception of needs and desire for care, Top box = Acceptability - Professional values, norms, culture, gender, Bottom box = Ability to seek - Personal and social values, culture, gender, autonomy; 3. Central box = Healthcare seeking, Top box = Availability and accommodation - Geographic location, Accommodation, Hours of opening, Appointments mechanisms, Bottom box = Ability to reach - Living environments, Transport, Mobility, Social Support; 4. Central box = Healthcare reaching, Top box = Affordability - Direct costs, Indirect costs, Opportunity costs, Bottom box = Ability to pay - Income, Assets, Social capital, Health insurance; 5. Central box = Healthcare utilisation, primary access, secondary access, Top box = Appropriateness - Teaching and interpersonal quality, Coordination and continuity, Bottom box = Ability to engage - Empowerment, Information , Adherence, Caregiver support; 6. Central box = Healthcare consequences, Economic, Satisfaction, Health.

(Click to expand)

Figure 1. Levesque’s framework of healthcare access

Let’s consider these factors in the context of healthcare for children with developmental disabilities. How can we alleviate barriers and challenges to healthcare access that may occur in supply and demand? Here are some examples:

SUPPLY

Approachability

  • Improving accessible outreach, for instance community-based, rather than school-based mass drug administration to promote inclusion of children with developmental disabilities.
  • Providing accessible health promotion and information, such as including pictures of children with developmental disabilities in material and providing information in different formats (e.g. Easyread, braille).

Acceptability

  • Improve professional attitudes through staff training on disability awareness. Availability and accommodation
  • Provide appointment mechanisms better suited to children with developmental disabilities, such as longer time slots.
  • Consider offering appointments closer to the community to improve geographic accessibility.
  • Ensure that facilities are physically accessible (e.g. ramps, adjustable furniture). Affordability
  • Offer subsidies for transport and consolidate appointments in order to reduce costs incurred by families.

Appropriateness

  • Put in place mechanisms for collaboration between service providers to enable coordinated care between different professionals.
  • Ensure clear referral pathways and information sharing between different healthcare specialists.

A boy is smiling at the camera. © Holt International

DEMAND

Ability to perceive

  • Provide health education to improve health literacy and change health beliefs. Ability to seek
  • Counsel parents so that they understand how they can seek required treatment, including through parent support programmes.

Ability to reach

  • Provide transport subsidies and information about available services.

Ability to pay

  • Offer health insurance connected to disability allowances, or social protection that will cover the additional healthcare costs incurred. Ability to engage
  • Empower parents to improve their ability to access healthcare by working in partnership with parents and children.
  • Include children in discussions about their own health.

The barriers that exist to accessing healthcare won’t be the same in all settings, and the interventions needed will therefore vary. What is important is that people with disabilities (including children with developmental disabilities), and their families, are involved in developing these strategies to improve access to healthcare, ensuring that they are acceptable and addressing real needs. Healthcare professionals need to be involved at all stages to make sure that the interventions are feasible and appropriate.

Discussion

We’d like you to think about the healthcare setting in which you work. Can you share ideas or experiences on how to improve access to healthcare for children with developmental disabilities? What support would you require?

We look forward to hearing your ideas!

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This article is from the free online course:

Integrated Healthcare for Children with Developmental Disabilities

London School of Hygiene & Tropical Medicine