According to the World Health Organization (WHO), there are approximately one billion people with disabilities (PwDs), making up 15% of the world’s population. The Fourth Rwanda Population and Housing Census (2012 RPHC) report revealed that about 5.2% of males and 4.8% of females live with disabilities. Disability is an important public health issue in many low and middle-income countries. Disablism is term that is defined as discriminatory, oppressive or abusive behaviour arising from the belief that disabled people are inferior to others. Historically, the rights and aspirations of Persons with Disabilities (PwDs) have been marked by resilience and struggle. People with Disabilities, possessing the same inherent rights as their non-disabled counterparts, have grappled with a legacy of adversity that goes beyond the physical barriers they face. Negative beliefs, regressive stereotypes, and prejudiced attitudes have cast shadows upon the journey of PwDs. Creating an environment that all individuals, including those with disabilities, can use is a key component of increasing accessibility. People frequently think only about making a building or other location wheelchair accessible when we talk about accessibility, and they rarely consider alternative options. However, true accessibility is considering a wide range of disabilities and how to take action to help those who need it. This includes not just making physical structures accessible but also changing people's attitudes and communication techniques. Barriers to disability aren’t always obvious, especially to able-bodied people. To the uninitiated eye, these barriers may not be apparent or clear. When we talk about disability, many people immediately think about a person on a wheelchair or crutches, but this is only a fraction of people with disabilities. We should also think about people with other forms of impairment like vision or hearing, intellectual disabilities, disability due to age and so on. Physical or other forms of access for people with disabilities are crucially important for an inclusive society but for purposes of this article, I will dwell on barriers to accessing health care services for PwDs as they may have specific health needs due to their disabilities and associated health conditions. Evidence indicates that people with disabilities have greater health needs than people without disabilities and that these needs are generally not met. Potential challenges faced in accessing health care include discrimination, physical inaccessibility, information inaccessibility and unavailability. Around the world, evidence on how to promote the inclusion of people with disabilities in the health system is lacking, According to the national policy of persons with disabilities and the strategic plan in the Rwanda Ministry of Local Government developed in 2021, accessing healthcare in all its forms is challenging for PwDs because of associated costs, distance from service providers, and systemic and institutional healthcare practices and barriers. Health service access data does not disaggregate by disability which undermines planning and decision making. Eleven of the Sustainable Development Goals (SDGs) require disaggregation by disability. Disaggregated disability data is important if achievements in health care recorded by Rwanda are to be extended to all citizens. In addition, there is little documented evidence about the physical and social barriers that PwDs may face in accessing health services. Although there is strong political commitment on the part of the Rwandan Government to address inequalities and discrimination faced by people with disabilities, there is still a gap between policies and their implementation. Legislative and programmatic initiatives to support people with disabilities have been implemented but more needs to be done to ensure these specific challenges are addressed especially about access to healthcare under these six characteristics; approachability, acceptability, availability, accommodation, affordability and appropriateness. To achieve a barrier free society, we will need to accelerate availability and affordability of services tailored for PwDs, building the capacity of healthcare providers to provide disability-related health services, creation of appropriate infrastructure and signage for PwDs and health sectors policies and strategies that recognise disability as a serious barrier to health care access. Other non-health related stakeholders such as education, justice, gender, and others also have a crucial role to play to ensure success of these policies as most factors are interrelated and influence each other. Addressing the challenges faced by Persons with Disabilities requires an approach that extends beyond healthcare. While acknowledging the political commitment of the Government, there remains a critical need for bridging the gap between policy intentions and their on-the-ground impact. We will have to move beyond just the removal of physical barriers to a shift in culture, attitudes and environment that embraces all individuals equally.
